Cystoscopy view of Urethra before and after the O-Shot® procedure

Case Report

48 year old G5P2 perimenopausal female presents with menorrhagia, uterovaginal prolapse and urinary incontinence. Patient demonstrated stress urinary incontinence on formal urodynamics testing (Laborie Medical). During preoperative counseling, patient expressed she did not want to have any polypropylene sling placed. Discussed the injection of platelet rich plasma (O Shot) and patient signed formal consent.

She underwent an uncomplicated robotically assisted total laparoscopic hysterectomy with anterior and posterior colporrhaphy. Patient’s blood was harvested and centrifuged utilizing the Stryker Vitagel kit. During the last step of the procedure, cystoscopy was performed (Figure 1) with a 30-degree cystoscope (Stryker). 4 cc of platelet rich plasma with 0.2 cc of 10% of CaCl was injected 1” from hymenal ring with 27 Gauge needle and 1 cc of platelet rich plasma with 0.05 of 10% of CaCl was injected into the clitoris.

5 minutes after the O shot was performed, a 30-degree cystoscope was inserted again which revealed ureteral jets bilaterally as well as the view of the urethral sphincter shown in Figure 2.

Postoperatively, patient came back to my office 1 week later. She did not have any urinary leakage and was satisfied with the outcome. Shown in Figure 3 and Figure 4 are before and after of the vaginoplasty.
These images are available in my realself.com gallery

Patient has signed permission to use her images as long as she was deidentified. This release waiver is signed and filed in my office.

Urethral Bulking for Female Stress Urinary Incontinence
There have been similar results described in the literature with synthetic soft tissue bulking agents such as Macroplastique. One of the side effects, however is granuloma formation.

Future
This case has inspired me to use formal urodynamics study how the urethral pressures change during the placement of platelet rich plasma in the Grafenberg spot. Using wireless Bluetooth catheters may quantify and guide to clinician with greater accuracy on where (and possibly how much) volume of platelet rich plasma to inject for optimal result with regard to treating urinary incontinence.

Edward Tangchitnob, MD, FACOG

Medical Director, Center of Excellence for Minimally Invasive Gynecologic Surgery
Master Surgeon in Robotic Surgery, Surgical Review Committee
www.tangchitnobMD.com

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