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Professional articleUrogynecologyEvidence reviewed 15 Sep 2026
PRP for stress urinary incontinence: what do the clinical studies actually show?
Platelet-rich plasma (PRP) is being investigated as a regenerative approach for female stress urinary incontinence (SUI). Several randomized studies and a 2026 meta-analysis are now available. The evidence remains conflicting: one rigorous sham-controlled trial reported benefit, while a placebo-controlled trial of similar size did not.
2 sham/placebo RCTs50 women each – with opposite results.
5 randomized studiesin women, but with different comparators and protocols.
not standard therapyPRP is not listed as an established SUI treatment in current guidelines.
Scope: This article summarizes the research for medical professionals. It is not a treatment recommendation or injection protocol. Injection sites, volumes and session numbers are described only to interpret published studies.
Does PRP work for stress urinary incontinence?
Short answer: There are clinical signals of possible benefit, particularly with repeated treatments. However, the evidence is not sufficient to classify PRP as an established or guideline-supported treatment for female SUI. The strongest direct sham/placebo evidence is contradictory.
In 2024, Grigoriadis et al. reported subjective cure in 32% after two periurethral PRP treatments versus 4% with saline sham, with a more favorable 1-hour pad test at six months. Ashton et al., by contrast, found no significant advantage over saline after a single 5-mL treatment.
This neither proves a general treatment effect nor closes the question. The key issue is whether patient selection, anatomical target, PRP characterization and number of sessions materially influence outcomes.
Where could PRP theoretically act?
SUI may involve urethral hypermobility and/or intrinsic sphincter deficiency. PRP hypotheses concern both connective-tissue support and sphincter function. Actual regeneration in humans has not been demonstrated.
Mechanism 1
Hypermobility and connective tissue
Impaired urethral support and changes in the pubourethral support structures can compromise closure during increased abdominal pressure. A biological PRP hypothesis and an animal model exist for this pathway.
Not shown: restoration of a damaged ligamentous support system in humans.
Mechanism 2
Intrinsic sphincter deficiency
Proposed effects include growth-factor signalling related to fibroblasts, collagen synthesis, neovascularization and possibly myogenic or neuromuscular processes. Clinical series have specifically studied PRP in sphincter deficiency.
Not shown: histologic or imaging-confirmed sphincter regeneration in humans.
Important limit: No clinical report has demonstrated the proposed regenerative mechanism using sphincter biopsy, robust pre/post imaging or complete biological characterization of the injected PRP. The rationale is plausible, not verified.
The key randomized studies
Five randomized studies in women are available. For the independent PRP effect, however, the two saline-controlled trials are most informative; the other RCTs use active comparators or combination treatments.
positive signal
Grigoriadis et al., 2024
32 % vs. 4 %
50 women, double blind. Two PRP sessions 4–6 weeks apart, delivered at three urethral levels. Subjective cure at six months: 32% with PRP versus 4% with saline sham.
A significant advantage was also reported in the 1-hour pad test at six months.
no significant benefit
Ashton et al., 2024
no difference
50 women, single blind. One 5-mL session at three anterior vaginal wall sites at the level of the mid-urethra. No significant advantage over saline was found for the composite endpoint at six months.
The study argues against assuming that one treatment is reliably effective.
Study explorer
Use the filters to group the main clinical studies by design. Filtering changes the display only, not the evidence rating.
Grigoriadis 2024RCT
Positive signal for subjective cure and the 1-hour pad test at six months.
Ashton 2024RCT
No significant advantage for the primary composite endpoint.
Saraluck 2024RCT
The combination performed better on the pad test and several patient-reported outcomes.
Daneshpajooh 2021RCT
Both groups improved; the sling group performed clearly better in this small direct comparison.
Lu 20263-arm RCT
PRP alone was not superior to laser; the combination was reported as superior to both monotherapies. This was not a comparison with guideline-based standard treatment.
Chiang & Kuo 2022single-arm
50% met the study definition of success; complete dryness declined by month 12.
Borislavschi/Petca 2026cohort
Three periurethral PRP sessions 4–6 months apart; patient-choice allocation and important baseline differences limit comparison.
Abdellatif et al. 2026prospective
Study-defined classification: 18.5% cured, 22.2% improved, 59.3% non-responders; more favorable signals in milder SUI.
Why can the placebo-controlled studies reach opposite conclusions?
01
Single versus repeated treatment
The negative Ashton trial used one treatment. Grigoriadis repeated treatment after four to six weeks. Many positive observational studies also used multiple sessions.
This is a pattern, not proof of a dose-response relationship.
02
Different anatomical targets
Studies targeted the anterior vaginal wall, periurethral tissue, mid-urethra or urethral sphincter. “PRP injection for SUI” is therefore not yet a uniform intervention.
03
Different patient populations
Some studies recruited broadly, while others specifically included women with urodynamically confirmed intrinsic sphincter deficiency. Disease severity also differed.
04
PRP itself is not standardized
Platelet concentration, leukocyte content, activation status, centrifugation parameters and final composition are inconsistently reported.
Plausible interpretation: Several factors vary at the same time and could contribute to the conflicting results. Current data do not establish which of these factors, if any, is causally decisive.
The 2026 meta-analysis: positive, but with important methodological limitations
Utama et al. pooled eight studies with 257 participants: three RCTs and five quasi-experimental studies. Short-term improvements were reported for several symptom and quality-of-life outcomes, but statistical heterogeneity was very high for several endpoints.
Evidence graphic
Heterogeneity of selected pooled outcomes
I² describes statistical inconsistency between study results. Very high values make a single pooled interpretation less secure.
UDI-6 · 1 month
73.3 %
UDI-6 · 3 months
98.6 %
ICIQ-SF · 1 month
82.2 %
ICIQ-SF · 3 months
49.1 %
IIQ-7 · 3 months
98.3 %
Why ALPP should not become the headline argument
The pooled increase in abdominal leak point pressure looks statistically striking but is based only on small uncontrolled datasets. The EAU explicitly recommends not using urethral pressure profilometry or leak point pressure to grade incontinence severity. Pad tests and validated patient-reported outcomes are more useful for clinical interpretation.
Who might respond? Early signals, but no validated responder profile
A 2026 prospective study by Abdellatif et al. followed 54 women after ultrasound-guided periurethral PRP for up to nine months. The authors reported more favorable results in milder SUI and associations with younger age and lower parity.
18.5 %
cured
Study-defined classification; uncontrolled prospective cohort, n=54.
22.2 %
improved
Study-defined classification; uncontrolled prospective cohort, n=54.
59.3 %
no response
Study-defined classification; uncontrolled prospective cohort, n=54.
These percentages should not be read as general success rates. Without a randomized control arm, placebo effects, regression to the mean, selection and other influences cannot be adequately separated.
What was actually done in the studies?
This overview is for scientific interpretation only and is not a treatment protocol. The differences between studies are themselves a major reason why no standard protocol can currently be derived.
| Parameter | Range in the literature | Why it matters |
|---|---|---|
| PRP volume | usually about 3–5 mL per session | Volume and distribution differ between studies. |
| Sessions | 1–4 | Positive signals are more common in studies using repeated treatment; an optimal schedule has not been validated. |
| Interval | often 4–6 weeks; some cohorts differ markedly, e.g. 4–6 months | No uniform repeat interval is established. |
| Anatomical target | anterior vaginal wall, periurethral, mid-urethra, urethral sphincter | The interventions are not anatomically or technically identical. |
| Platelet enrichment | where reported, sometimes about 2.5- to 5-fold | Many publications incompletely characterize the final PRP product. |
| Centrifugation | different systems, rotors and protocols | RPM values cannot be transferred to another centrifuge without the effective rotor radius or RCF. |
Safety: mostly well tolerated short term, but long-term data are lacking
No life-threatening complications were reported in the small studies available. Reported events were mainly mild and self-limiting, such as haematuria, dysuria, vaginal spotting or local discomfort; transient voiding difficulty occurred in one series.
supported
In the cohorts studied so far, reported adverse events were predominantly mild and temporary.
not established
Comprehensive long-term safety is not established. Sample sizes are small, and follow-up in women generally does not extend beyond twelve months.
What do guidelines say – and how should PRP be framed legally?
EAU 2026
PRP is not a listed standard treatment
The EAU recommends supervised intensive pelvic floor muscle training for at least three months as first-line therapy and describes established invasive and surgical options. PRP is not listed as an established SUI treatment in that chapter.
The 2026 EAU edition is essentially a reprint of the 2025 version with minor formatting changes. Its recommendation to use new devices only within structured research programmes must not be misrepresented as a PRP-specific recommendation.
Germany
PRP involves more than the injection itself
In Germany, autologous PRP requires separate consideration of blood collection, preparation, administration, medical responsibility and, where applicable, notification obligations. The relevant medicinal-product and transfusion-law requirements depend on the practice setup.
This article provides professional orientation and is not legal advice. The linked PRPmed legal overview discusses the German situation in greater detail.
Communication boundary: Claims such as “guideline compliant”, “alternative to sling surgery”, “proven efficacy” or “free of side effects” are not supported by the current evidence. A defensible wording is: PRP is being clinically investigated for SUI; the evidence is inconsistent.
What can the 2026 evidence actually support?
supported
What we can say
- PRP has been investigated in several clinical studies in women with SUI.
- Both positive and negative randomized data exist.
- Repeated treatments show positive signals more often than a single session, but no optimal schedule has been proven.
- Reported adverse events have mostly been mild and temporary.
- Lack of PRP product standardization is a central methodological problem.
not established
What we cannot claim
- PRP reliably cures female SUI.
- PRP has been shown to regenerate the urethral sphincter in humans.
- PRP is equivalent to a midurethral sling or other established treatments.
- Two, three or four sessions constitute a validated standard regimen.
- RPM or product data from one study can be directly transferred to another PRP system.
Research needed: Larger well-controlled RCTs are needed with clearly defined SUI subgroups, full PRP characterization, objective pad-test outcomes, validated questionnaires and longer follow-up. Only then can we determine whether there is a reproducible effect and which patients may benefit.
Frequently asked questions
Is PRP for stress urinary incontinence scientifically proven?
No. There are positive clinical signals and several randomized studies, but the results are inconsistent. One double-blind sham trial showed benefit, while a similarly sized placebo-controlled trial did not.
Is there a standardized PRP protocol for SUI?
No. Published studies used different volumes, anatomical targets and one to four sessions. No validated standard regimen can be derived from these data.
Is PRP an alternative to sling surgery?
That has not been established. In a small randomized direct comparison, the suburethral sling performed better. PRP has not been shown to be equivalent to established surgical treatments.
Do guidelines recommend PRP for female SUI?
No. Current guidelines do not list PRP as an established standard treatment.
Which endpoints are particularly informative?
Pad tests, standardized clinical stress tests and validated patient-reported instruments are especially relevant. An isolated increase in ALPP should not be overinterpreted.
Selected primary sources and guidelines
- Grigoriadis T, Kalantzis C, Zacharakis D, et al. Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence — A Randomized Trial. Urogynecology. 2024;30(1):42–49. DOI
- Ashton L, Nakatsuka H, Johnson CM, et al. A Single Injection of Platelet-rich Plasma Injection for the Treatment of Stress Urinary Incontinence in Females: A Randomized Placebo-controlled Trial. Urology. 2024;193:63–68. DOI
- Saraluck A, Chinthakanan O, Kijmanawat A, et al. Autologous platelet rich plasma (A-PRP) combined with pelvic floor muscle training for the treatment of female stress urinary incontinence: a randomized control clinical trial. Neurourol Urodyn. 2024;43(2):342–353. DOI
- Daneshpajooh A, Mirzaei M, Farsinejad A, et al. The Effect of Periurethral Injection of Pure Platelet-rich Plasma in the Treatment of Urinary Incontinence in Female Patients: a randomized clinical trial. J Kerman Univ Med Sci. 2021;28(4):330–337. DOI
- Lu M, Liu W, Wu Y, Deng K. A Randomized Controlled Trial of Platelet-Rich Plasma Combined with Fractional CO₂ Laser Therapy for Mild and Moderate Stress Urinary Incontinence in Women. Int Urogynecol J. 2026;37(2):461–468. DOI
- Utama BI, Birru ABA, Cuandra KN, et al. Therapeutic efficacy and safety of injectable platelet-rich plasma in women with stress urinary incontinence: a systematic review and meta-analysis. Front Med. 2026;13:1728478. DOI
- Chiang CH, Kuo HC. The Efficacy and Mid-term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence. Front Pharmacol. 2022;13:847520. DOI
- Long CY, Lin KL, Shen CR, et al. A pilot study: effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence. Sci Rep. 2021;11:1584. DOI
- Jiang YH, Lee PJ, Kuo HC. Therapeutic Efficacy of Urethral Sphincter Injections of Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence due to Intrinsic Sphincter Deficiency: A Proof-of-Concept Clinical Trial. Int Neurourol J. 2021;25(1):51–58. DOI
- Abdellatif AEA, Elbadwy AA, Hasab El Naby AGM, Elmarakbi AA. Effectiveness and Feasibility of Transvaginal Ultrasound–Guided Platelet-Rich Plasma Injection for the Management of Female Stress Urinary Incontinence. Int J Drug Deliv Technol. 2026;16(5s):365–369. DOI
- European Association of Urology. EAU Guidelines on Non-neurogenic Female LUTS, 2026. source
- Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline (2023). J Urol. 2023;209(6):1091–1098.