[Morphological analysis of the structure of parafistulous tissues in patients with vesicovaginal fistulas by the local interstitial application of platelet-rich plasma]

Abstract

The issue of complications of fistuloplasty of vesicovaginal fistulas (VVF) remains extremely relevant both for modern surgeons and for patients. Optimization of morphological characteristics by local interstitial application of Platelet-Rich Plasma (PRP) can positively affect the results of surgical treatment of VVF.

Purpose of the study: to conduct a comparative assessment of the morphological parameters of parafistulous tissues before and after local interstitial application of PRP.

Materials and methods: Study included 52 patients who underwent fistuloplasty. Group I included 30 women who were treated according to the standard method. Group II included 22 patients who underwent PRP therapy prior to surgery. All patients underwent an excisional biopsy of the VVF edges. After performing an excisional biopsy, Group II patients received 9-10 parafistulic injections of activated PRP with a frequency of one every seven days for five weeks before fistuloplasty. Repeated biopsy of the VVF edges was performed in Group II patients immediately before fistuloplasty. For histological study, tissue sections were stained with hematoxylin and eosin according to standard technology.

Results: Primary biopsy revealed keratinization disorders in eight (37 percent) patients from Group II, and after PRP therapy in four (18 percent) patients (p>0.05). In all patients of Group II, after PRP therapy, the epithelial layer had a normal histological structure (p<0.05). Erosive and ulcerative lesions of the integumentary epithelium were initially detected in 14 patients (64 percent) from Group II. No erosions were detected during control biopsy (p<0.05). The thickness of fibrous tissue in Group II before the therapy was 886.3+/-113.5 M, and 830.1+/-119.9 M (p=0.66) after. Lymphoid infiltration was initially present in 20 patients from Group II, in eight of them (40 percent) it decreased (p<0.05) after the therapy. Cell density decreased after PRP therapy in 11 patients (50 percent), but in four (18 percent) patients it increased from low to moderate (p<0.05). Microvascular density before therapy was 29+/-3,3, and 19.9+/-1.9 after. The difference has statistical validity at the trend level (p=0.078).

Conclusion: Taking into account a statistically significant decrease in the activity of the inflammatory process, complete relief of erosive and ulcerative lesions, and decrease in the thickness of fibrosis in the stromal layer in fistula tissues, application of PRP therapy in the surgical treatment of VVF should be considered appropriate and justified.

Keywords: morphology; platelet-rich plasma; regenerative medicine; vesicovaginal fistula.