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Platelet-Rich Plasma (PRP)

Platelet-rich plasma (PRP) is an autologous blood-derived biologic studied across urologic and urogynecologic conditions. These applications remain investigational. Two 2026 IC/BPS meta-analyses report symptom improvement, predominantly from uncontrolled studies; pooled before/after changes do not establish benefit over placebo or standard care.[1][2] PRP has also been studied as an adjunct to internal urethrotomy, for female SUI and male post-prostatectomy incontinence, erectile dysfunction, Peyronie's disease, genital lichen sclerosus, and hypospadias-repair complication prevention. The dominant cross-cutting limitation across urology is the lack of standardization in preparation protocols, concentrations, activation methods, and dosing.[3][4]

This article is the class-level hub across urologic PRP applications. For narrower deep-dives, see Antimitotics & antifibrotics (PRP as a stricture adjunct among other antifibrotics), Peyronie's disease agents (PRP as one of several intralesional options), and Intravesical IC/BPS agents (the broader instillation armamentarium).

Mechanism and preparation​

PRP is produced by centrifugation of autologous whole blood, yielding a platelet concentrate at 2–7× baseline.[5][6] After activation (thrombin, calcium chloride, or collagen), platelet α-granules release a growth-factor cascade:[5][7]

FactorRole
PDGFFibroblast recruitment and proliferation
TGF-βECM synthesis and remodeling (can also drive fibrosis — see caveat below)
VEGFAngiogenesis and revascularization
IGF-1, EGF, bFGF, HGFCell proliferation, differentiation, tissue regeneration

Proposed regenerative mechanisms include revascularization, connective-tissue remodeling and effects on progenitor cells; these mechanisms do not establish clinical benefit for a particular urologic indication.[5] Autologous sourcing reduces donor-related concerns but does not eliminate contamination, injection injury or reactions to additives. Infection control remains essential.[34]

Classification and standardization problem​

Classification systems include Dohan Ehrenfest (P-PRP, L-PRP, P-PRF, L-PRF based on leukocyte and fibrin content) and the PAW, DEPA, and MARSPILL systems.[8][4] Across urologic PRP literature, there is no standard for:[4]

  • Single vs double spin; target platelet concentration
  • Leukocyte content (leukocyte-rich vs leukocyte-poor)
  • Activation method
  • Injection volume, number of sessions, and session interval
  • Outcome measures and follow-up

This is the single biggest obstacle to cross-study comparison and clinical adoption.

IC/BPS — investigational bladder-wall injections​

Two 2026 meta-analyses define the current evidence.

Meta-analyses​

  • Ali 2026 (8 studies) — intravesical PRP improved VAS pain (pooled SMD −0.78; 95% CI −1.15 to −0.41; p < 0.001), urinary frequency, O'Leary-Sant ICSI / ICPI scores, cystometric capacity, and GRA responder rates.[1]
  • Simões 2026 — confirmed the signal but noted all included studies were quasi-experimental / uncontrolled / non-randomized; overall evidence level low. Mean GRA ≥ 2 success rate 48%.[2]

Key prospective data​

StudynProtocolFinding
Jiang 202040 refractory IC/BPS4 monthly intravesical injections (10 mL, 2.5× concentration)GRA ≥ 2 70.6% at 1 mo and 76.7% at 3 mo after 4th injection; urinary biomarkers showed ↓ NGF, MMP-13, VEGF with ↑ PDGF-AB[9]
Xu 2026102 non-ulcerative primary BPSNovel 2-phase protocol — weekly × 3 wk, then monthly × 3 mo; apheresis-derived PRPHigher cystoscopic hydrodistention grades (II–III) showed greater and more durable improvement than Grade I; cystoscopic grade was the only independent predictor of response[10]
Jiang 2022 (dose-finding)ComparativeSingle high-dose (100 mL blood) vs 4 low-dose (50 mL blood)4 low-dose injections superior to single high-dose at 6 mo; saline-vs-plasma vehicle and injection site number (20 vs 40) had no effect[11]

Practical takeaway​

Four monthly sessions are a studied protocol, not an established standard. Hydrodistention grade and biomarkers are exploratory correlates; uncontrolled studies cannot distinguish treatment benefit from placebo, regression to the mean or co-interventions. See Intravesical IC/BPS agents for the broader instillation framework including triamcinolone for Hunner lesions.

Urethral stricture — adjunct to internal urethrotomy​

The single RCT evidence base is covered in Antimitotics & antifibrotics. Key points repeated here for reference:

  • Rezaei 2019 RCT (n = 87, bulbar strictures) — IU + submucosal PRP vs IU + saline: 12-mo recurrence 9.09% vs 26.82% (p = 0.032); 24-mo recurrence 21.95% vs 43.90%. The indexed abstract prints p = 0.34 while EAU reports p = 0.034; this discrepancy precludes asserting that efficacy disappeared at two years[12]
  • Aydın 2020 rat urethral-trauma model — PRP reduced mucosal inflammation, spongiofibrosis, and edema[13]
  • Tavukcu 2018 — PRP normalized the collagen I:III ratio toward uninjured controls in a rat urethral-injury model[14]
  • Gul 2016 hypothesis — TGF-β1-neutralization-antibody-modified PRP could further enhance antifibrotic effect by eliminating the pro-fibrotic growth-factor component while preserving regenerative activity[15]

The TGF-β paradox is worth noting: PRP delivers TGF-β (pro-fibrotic) alongside regenerative factors, and the net antifibrotic effect observed in urethral studies suggests either dose-dependent biphasic response or that the other factors dominate in this tissue. Modified PRP engineering may refine this.

Stress urinary incontinence​

Female SUI​

Utama 2026 systematic review + meta-analysis (8 studies, 3 RCTs + 5 quasi-experimental; n = 257) — PRP significantly improved symptom severity (UDI-6, ICIQ-SF) with:[16]

  • Abdominal leak-point pressure ↑ (MD +51.07 cmH₂O; 95% CI 36.21–65.93; p < 0.001)
  • Significant reduction in 1-hour pad weight
  • Significant improvement in patient-reported symptoms
StudynKey finding
Saraluck 2023 RCT60A-PRP + PFMT vs PFMT alone — A-PRP arm had 8 g greater reduction in 1-h pad weight; symptom improvement sustained at 2 and 5 mo; no AEs[17]
Chiang & Kuo 202226 ISD4 monthly urethral-sphincter injections — GRA ≥ 2 50%; complete dryness 46.2% initial / 26.9% at 12 mo; ALPP 117.5 → 133.6 cmH₂O (p = 0.045)[18]
Long 202120Anterior vaginal wall / mid-urethral A-PRP injection — significant symptom improvement at 1 and 6 mo; trend toward better outcomes in younger patients (p = 0.07)[19]

Male post-prostatectomy incontinence​

Lee 2021 prospective (n = 28 PPI, 4 monthly urethral-sphincter injections):[20]

  • Complete continence (pad-free): 21.4%
  • GRA ≥ 2 success rate: 71.4%
  • GRA ≥ 1 clinical improvement: 92.9%
  • VAS SUI 6.5 → 3.5 (p < 0.001)

Erectile dysfunction — conflicting RCTs​

ED trials have conflicting results. Masterson 2023 is not the only double-blind placebo-controlled RCT: Poulios 2021 randomized 60 men and reported benefit. EAU still restricts intracavernosal PRP to clinical trials.[32][33]

Masterson 2023 (negative RCT)[21]​

Double-blind placebo-controlled (n = 61 mild-to-moderate ED, 2 intracavernosal PRP vs placebo):

  • No difference in MCID achievement (58.3% PRP vs 53.6% placebo; p = 0.730)
  • No difference in IIEF-EF scores at any timepoint
  • No change in penile Doppler parameters
  • PRP was safe but showed no efficacy over placebo

Shaher 2023 (positive RCT)[22]​

Single-blind randomized (n = 100, 3 PRP vs saline): significant improvement in IIEF-EF, SEP Q2/Q3, and duplex parameters at 1, 3, and 6 mo (p < 0.05).

Du 2024 meta-analysis[23]​

12 controlled trials (n = 991) + 11 single-arm (n = 377) — PRP better than controls: IIEF SMD +0.59 (95% CI 0.34–0.84); MCID RR 1.94 (95% CI 1.33–2.83). Authors stressed the need for further high-quality trials.

Practical interpretation: differences in preparation, eligibility, co-treatment and analysis limit comparison. Blinding alone does not justify selecting one result as the true effect or attributing all positive trials to placebo. See PDE5 inhibitors for the established pharmacologic first-line.

Peyronie's disease — early signal​

Ledesma 2024 Phase 2 RCT crossover design (n = 41; preliminary analysis of 28) — PRP safe with no AEs. PRP-placebo group: curvature 40° → 25° at 6 mo (p = 0.047). Placebo-PRP group: curvature to 32.5° (p = 0.490); PDQ reduction significant (p = 0.020) — a delayed effect was hypothesized, but within-sequence changes in a preliminary crossover analysis do not establish a causal benefit over placebo.[24]

Asmundo 2024 systematic review — PRP studies for PD generally showed small-to-moderate benefits with mild transient side effects; protocol variation, small samples, and short follow-up limit interpretation.[4]

See Peyronie's disease agents for the Dachille 2025 and Zugail 2024 PRP data alongside CCH, IFN, and verapamil.

Vulvar lichen sclerosus​

PRP remains investigational for genital LS. The controlled evidence should take precedence over satisfaction rates from uncontrolled series.

  • Goldstein 2019 placebo-controlled RCT: 30 women randomized 2:1 to PRP or saline; 29 completed treatment. After two injections six weeks apart, histological inflammation improved in 5/19 PRP recipients and 5/10 controls, with no between-group difference (p = 0.542). Patient symptom scores also showed no advantage (p = 0.654). Bruising was the only reported adverse effect, but the small trial cannot establish uncommon-harm safety.[35]
  • El Attar 2026 review: one RCT alongside predominantly uncontrolled reports. Improvements in symptoms, sexual function or tissue quality in those reports do not establish benefit over placebo or corticosteroids.[25]
  • Boero 2024 and Medina Garrido 2023: uncontrolled studies in refractory vulvar LS reported symptom improvement; the Boero pilot's 100% satisfaction result is not a comparative efficacy estimate.[26][27]
  • Tedesco 2020: exploratory disease-stage findings with adipose stromal vascular fraction plus PRP do not establish a validated early-versus-late LS treatment sequence.[28]
  • Sun 2025: platelet-rich fibrin (PRF) mechanistic findings are not interchangeable with clinical PRP efficacy or evidence of cancer prevention.[29]

The German S3 guideline gives PRP in adult genital LS an open recommendation, meaning no recommendation for or against, and recommends against it in children. It does not establish PRP as standard rescue treatment.[36] See clinical LS for the laser comparisons and topical corticosteroids for first-line treatment. Neither symptom improvement nor an autologous source removes the need for inflammation control and surveillance.

Hypospadias repair — complication prevention​

Eryilmaz 2020 RCT (n = 40 pediatric mid-penile hypospadias, Snodgrass TIPU ± PRP graft): PRP group had lower rates of postoperative urethrocutaneous fistula, urethral stenosis, and infection — both early and long-term. PRP has plausible role in preventing the most common complications of hypospadias repair.[30]

One cautionary preclinical signal — renal ischemia-reperfusion​

Martín-Solé 2016 rat model — subcapsular PRP injection resulted in worse kidney blood flow (p = 0.045) and more histopathologic damage (p < 0.05) in ischemia-reperfusion injury.[31]

PRP should not be assumed universally beneficial across urologic tissues. The renal-parenchymal signal argues against empiric intraparenchymal use in partial nephrectomy or renal-trauma settings without further evidence.

Safety — limited detection of uncommon harms​

DomainSignal
Common AEsMild, self-limiting — dysuria, transient hematuria, micturition pain, UTI[1][20][21]
Serious AEsSmall cohorts and incomplete reporting cannot exclude uncommon or delayed harm
Infection / reactionsAutologous sourcing does not replace sterile processing; additives and procedure-related harms must be considered[34]
Preparation standardizationPoor across studies — the main source of heterogeneity[4]
Renal IR cautionary signalPreclinical (Martín-Solé 2016) — argues against empiric intraparenchymal use[31]

Summary by indication​

IndicationRouteBest evidenceKey outcomeVerdict
IC/BPS (refractory)Intravesical injection2 meta-analyses; Jiang 2020, 2022; Xu 2026VAS SMD −0.78; GRA ≥ 2 in 48–77%Investigational; mostly uncontrolled improvement[1][2][9][10]
Urethral strictureSubmucosal at IU1 RCT (Rezaei)9% vs 27% recurrence at 12 moInvestigational; indirect comparisons do not rank agents — see Antimitotics[12]
Female SUIPeriurethral / sphincterUtama 2026 meta; Saraluck 2023 RCTALPP +51 cmH₂O; pad weight −8 gPromising — small studies, short follow-up[16][17]
Male PPIUrethral-sphincter injectionLee 2021 prospective71.4% GRA ≥ 2; 21.4% pad-freeSingle study; no control[20]
Erectile dysfunctionIntracavernosalConflicting placebo-controlled trialsInconsistent efficacyEAU clinical-trial-only use[21][22][33]
Peyronie's diseaseIntralesionalLedesma 2024 Phase 2 RCT (preliminary)Curvature 40° → 25° at 6 moPreliminary crossover findings; see Peyronie's disease agents[24]
Vulvar lichen sclerosusIntralesionalSmall saline-controlled RCT plus uncontrolled reportsNo histological or symptom advantage in the RCTInvestigational; not established steroid-refractory care[25][35]
Hypospadias repairGraft applicationEryilmaz 2020 RCTLower fistula / stenosis / infectionSmall single study[30]
Renal ischemia-reperfusionSubcapsular / parenchymalPreclinical (Martín-Solé 2016)Worse blood flow, more damageAvoid[31]

Evidence Summary​

IndicationEvidence and limitsKey source
IC/BPSPredominantly uncontrolled before/after studiesAli 2026[1]; Simões 2026[2]; Jiang 2020[9]
Urethral strictureSingle RCT; replication and standardization neededRezaei 2019[12]
Female SUISmall trials and heterogeneous synthesisUtama 2026[16]; Saraluck 2023[17]
Male PPIUncontrolled pilot evidenceLee 2021[20]
EDConflicting placebo-controlled RCTsMasterson 2023 negative[21]; Shaher 2023 positive[22]
Peyronie'sEarly phase 2 trial evidenceLedesma 2024[24]
Vulvar LSSmall negative placebo-controlled RCT; uncontrolled studies remain exploratoryGoldstein 2019[35]; El Attar 2026[25]
HypospadiasLimited comparative evidenceEryilmaz 2020[30]
Renal IR cautionPreclinicalMartín-Solé 2016[31]

Clinical Positioning​

  • Keep PRP within research-oriented care rather than a routine treatment step. In ED, current EAU guidance explicitly limits intracavernosal PRP to clinical trials.[32]
  • IC/BPS before/after improvements do not establish a standard injection regimen. PRP bladder-wall injection should not be equated with guideline-supported DMSO/heparin/lidocaine instillation or placed in a numbered AUA ladder.[1][2]
  • Do not position PRP routinely before AUS, instead of a sling, or as a substitute for urethral reconstruction. The cited SUI/PPI and stricture studies are too small or uncontrolled to establish those treatment sequences.[12][16][17][20]
  • Peyronie, genital LS and hypospadias applications remain preliminary. Avoid promoting a within-group change, satisfaction rate or single small study to proven comparative efficacy.[24][25][30]
  • Record preparation, additives, dose, injection sites and outcomes in any protocol; counsel about uncertain benefit and procedure-related risks.[4]
  • Autologous does not mean infection-proof. CDC documented probable HIV transmission associated with unsafe PRP cosmetic procedures; this is not a urologic risk estimate, but demonstrates why handling and sterility matter.[34]
  • The renal ischemia-reperfusion harm signal is preclinical and does not justify empiric renal-parenchymal treatment.[31]

See Also​

References​

1. Ali F, Haseeb A, Khan HB, Maaz M, Mohammed W. "Efficacy of platelet-rich plasma in interstitial cystitis/bladder pain syndrome: a systematic review and meta-analysis." Int Urogynecol J. 2026. doi:10.1007/s00192-026-06579-7

2. Simões GCS, de Oliveira C, Gon LM, Riccetto CLZ. "Intravesical platelet-rich plasma injection for refractory interstitial cystitis/painful bladder syndrome: a systematic review and meta-analysis." Int Urogynecol J. 2026. doi:10.1007/s00192-026-06515-9

3. Sheean AJ, Anz AW, Bradley JP. "Platelet-rich plasma: fundamentals and clinical applications." Arthroscopy. 2021;37(9):2732–2734. doi:10.1016/j.arthro.2021.07.003

4. Asmundo MG, Durukan E, von Rohden E, et al. "Platelet-rich plasma therapy in erectile dysfunction and Peyronie's disease: a systematic review of the literature." World J Urol. 2024;42(1):359. doi:10.1007/s00345-024-05065-3

5. Etulain J. "Platelets in wound healing and regenerative medicine." Platelets. 2018;29(6):556–568. doi:10.1080/09537104.2018.1430357

6. Dos Santos RG, Santos GS, Alkass N, et al. "The regenerative mechanisms of platelet-rich plasma: a review." Cytokine. 2021;144:155560. doi:10.1016/j.cyto.2021.155560

7. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. "Platelet-rich therapies for musculoskeletal soft tissue injuries." Cochrane Database Syst Rev. 2014;(4):CD010071. doi:10.1002/14651858.CD010071.pub3

8. Marín Fermín T, Calcei JG, Della Vedova F, et al. "Review of Dohan Ehrenfest et al. (2009) on 'Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF).'" J ISAKOS. 2024;9(2):215–220. doi:10.1016/j.jisako.2023.07.010

9. Jiang YH, Kuo YC, Jhang JF, et al. "Repeated intravesical injections of platelet-rich plasma improve symptoms and alter urinary functional proteins in patients with refractory interstitial cystitis." Sci Rep. 2020;10(1):15218. doi:10.1038/s41598-020-72292-0

10. Xu S, Zhu Q, Wang C, et al. "Two-phase intravesical injection of apheresis-derived platelet-rich plasma for non-ulcerative primary bladder pain syndrome: a prospective single-center study." Urology. 2026;210:24–29. doi:10.1016/j.urology.2026.02.007

11. Jiang YH, Jhang JF, Lin TY, et al. "Therapeutic efficacy of intravesical platelet-rich plasma injections for interstitial cystitis/bladder pain syndrome — a comparative study of different injection number, additives and concentrations." Front Pharmacol. 2022;13:853776. doi:10.3389/fphar.2022.853776

12. Rezaei M, Badiei R, Badiei R. "The effect of platelet-rich plasma injection on post-internal-urethrotomy stricture recurrence." World J Urol. 2019;37(9):1959–1964. doi:10.1007/s00345-018-2597-8

13. Aydın A, Sönmez MG, Oltulu P, et al. "Histopathologic evaluation of the effects of intraurethral platelet-rich plasma in urethral trauma experimentally induced in rat model." Urology. 2020;141:187.e9–187.e14. doi:10.1016/j.urology.2020.03.025

14. Tavukcu HH, Aytaç Ö, Atuğ F, et al. "Protective effect of platelet-rich plasma on urethral injury model of male rats." Neurourol Urodyn. 2018;37(4):1286–1293. doi:10.1002/nau.23460

15. Gul M. "Modified platelet-rich plasma with transforming growth factor β1 neutralization antibody injection may reduce recurrence rate of urethral stricture." Med Hypotheses. 2016;97:1–3. doi:10.1016/j.mehy.2016.10.007

16. 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:10.3389/fmed.2026.1728478

17. 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 controlled clinical trial." Neurourol Urodyn. 2023. doi:10.1002/nau.25365

18. 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:10.3389/fphar.2022.847520

19. 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(1):1584. doi:10.1038/s41598-020-80598-2

20. Lee PJ, Jiang YH, Kuo HC. "A novel management for post-prostatectomy urinary incontinence: platelet-rich plasma urethral sphincter injection." Sci Rep. 2021;11(1):5371. doi:10.1038/s41598-021-84923-1

21. Masterson TA, Molina M, Ledesma B, et al. "Platelet-rich plasma for the treatment of erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled clinical trial." J Urol. 2023;210(1):154–161. doi:10.1097/JU.0000000000003481

22. Shaher H, Fathi A, Elbashir S, Abdelbaki SA, Soliman T. "Is platelet-rich plasma safe and effective in treatment of erectile dysfunction? Randomized controlled study." Urology. 2023;175:114–119. doi:10.1016/j.urology.2023.01.028

23. Du S, Sun S, Guo F, Liu H. "Efficacy of platelet-rich plasma in the treatment of erectile dysfunction: a meta-analysis of controlled and single-arm trials." PLoS One. 2024;19(11):e0313074. doi:10.1371/journal.pone.0313074

24. Ledesma BR, Velasquez DA, Egemba C, et al. "A Phase 2 randomized, placebo-controlled crossover trial to evaluate safety and efficacy of platelet-rich plasma injections for Peyronie's disease: clinical trial update." Int J Impot Res. 2024;36(8):813–817. doi:10.1038/s41443-024-00844-3

25. El Attar A, DeLucia C, Landau M, Kroumpouzos G. "Platelet-rich plasma in the management of genital lichen sclerosus: a review of mechanisms, evidence, and future directions." Clin Dermatol. 2026;44(2):356–362. doi:10.1016/j.clindermatol.2026.02.001

26. Boero V, Cetera GE, Caia C, et al. "Is there a role for platelet-rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study." Arch Gynecol Obstet. 2024;309(6):2719–2726. doi:10.1007/s00404-024-07424-2

27. Medina Garrido C, Cano García A, de la Cruz Cea L, Oreja Cuesta AB. "Mid-term symptomatic relief after platelet-rich plasma infiltration in vulvar lichen sclerosus." Arch Dermatol Res. 2023;315(6):1527–1532. doi:10.1007/s00403-023-02529-1

28. Tedesco M, Bellei B, Garelli V, et al. "Adipose tissue stromal vascular fraction and adipose tissue stromal vascular fraction plus platelet-rich plasma grafting: new regenerative perspectives in genital lichen sclerosus." Dermatol Ther. 2020;33(6):e14277. doi:10.1111/dth.14277

29. Sun SH, Fan HH, Wang XW, Bing BD, Hu YJ. "Platelet-rich fibrin attenuates inflammation and fibrosis in vulvar lichen sclerosus via the TGF-β/SMAD3 pathway." Arch Dermatol Res. 2025;317(1):360. doi:10.1007/s00403-025-03811-0

30. Eryilmaz R, Şimşek M, Aslan R, et al. "The effect of platelet-rich plasma graft on post-operative complications in mid-penile hypospadias." Andrologia. 2020;52(7):e13652. doi:10.1111/and.13652

31. Martín-Solé O, Rodó J, García-Aparicio L, et al. "Effects of platelet-rich plasma (PRP) on a model of renal ischemia-reperfusion in rats." PLoS One. 2016;11(8):e0160703. doi:10.1371/journal.pone.0160703

32. EAU. Sexual and Reproductive Health: Management of Erectile Dysfunction (2026), platelet-rich plasma. Guideline.

33. Poulios E, Mykoniatis I, Pyrgidis N, et al. Platelet-rich plasma improves erectile function: a double-blind, randomized, placebo-controlled clinical trial. J Sex Med. 2021;18:926–935. doi:10.1016/j.jsxm.2021.03.008.

34. CDC. Investigation of presumptive HIV transmission associated with receipt of platelet-rich plasma microneedling facials at a spa—New Mexico, 2018–2023. MMWR. 2024;73:372–376. Report.

35. Goldstein AT, Mitchell L, Govind V, Heller D. "A randomized double-blind placebo-controlled trial of autologous platelet-rich plasma intradermal injections for the treatment of vulvar lichen sclerosus." J Am Acad Dermatol. 2019;80(6):1788–1789. doi:10.1016/j.jaad.2018.12.060.

36. Kirtschig G, Woelber L, Günthert A, et al. "Evidence- and consensus-based guideline on lichen sclerosus." J Dtsch Dermatol Ges. 2026;24(4):566–584. doi:10.1111/ddg.70000. Full German S3 guideline, June 2025.