Interstitial Cystitis: Etiology, Pathophysiology, and the Potential Role of Platelet-Rich Plasma Instillation and Predictive Value of Potassium Chloride Sensitivity Test
Timothy J Hardy,
Prince Afrifie
Background and aims: To confirm platelet rich plasma with hydrodistention facilitates healing of
the barrier function of the urothelium and subsequently relieves symptoms of pain urgency frequency
confirmed by the potassium chloride sensitivity test.
Methods: Patients with diagnosis of interstitial cystitis were recruited to the study. The patient
completed the O'Leary Sant symptom and problem index and then underwent potassium chloride
sensitivity testing. After treatment with hydrodistention with platelet rich plasma instillation the testing
was repeated at 1 month and 3 months.
Interstitial cystitis is proposed to be caused by a defect in the gag layer of the urothelium which can be
identified by potassium chloride sensitivity test which is proposed to leak into the suburothelial layer
and stimulate subepithelial nerves and cause inflammation and subsequent urinary frequency urgency
and pain with bladder filling. Platelet rich plasma infusion has been shown in previously published
study by author to effectively treat interstitial cystitis. This study objective is to use the potassium
chloride sensitivity test to predict success of hydrodistention with platelet-rich plasma.
Materials and methods: The patients recruited for the study completed a validated questionnaire
O'Leary-Sant Symptom and Problem Index (OSPI) and underwent potassium chloride sensitivity test.
The testing was repeated at 1 month and 3 months. The analysis at 1 month showed 80% responsive
with 90% responsive in the positive potassium chloride sensitive test and 50% responsive in the negative
potassium chloride sensitivity test. As described in a previous paper 60 cc of autologous blood was
collected from the patient by phlebotomy and processed to provide 10 cc of platelet rich plasma. The
patient was placed in the dorsolithotomy position and after general anesthesia was induced the bladder
was visualized with cystoscopy and the bladder was distended with 80 cm of water pressure for 3
minutes. The bladder was drained and the platelet rich plasma was infused. The patient was instructed
to maintain the plasma rich plasma in the bladder for 2 hours. In the post procedure month all patients
were instructed to continue their usual medications and to avoid bladder irritants specifically caffeine
alcohol tobacco spicy foods and citrus. In accordance with University of Virginia ethical principles
for the protection of human subjects of biomedical behavioral research we adhered to the 3 principles
underlying the ethical conduct of research: respect for persons, beneficence and justice. Consent was
obtained from all participants.
Results: The median age of patients was 52.2 years old with the range of ages being 23-83.The
potassium sensitivity test was positive for 95%. At 3 months 92% had a negative potassium chloride
sensitivity test and low OSPI score.
Conclusion: Hydrodistention with platelet rich plasma is successful in treating patients with a positive
potassium chloride sensitivity test which aids in identifying patients with Interstitial cystitis. The
potassium chloride sensitivity test has an 95% predictive value for success of hydrodistention with PRP
In reducing urinary frequency urgency and pain with full bladder.
