POL Scientific / Bladder / Volume 11 / Issue 2 / DOI: 10.14440/bladder.2024.0017
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RESEARCH ARTICLE

Therapeutic efficacy and short-term durability of trans-urethral amniotic bladder injections for the treatment of refractory COVID-associated cystitis

Jack A. Considine1 ,  Kyle O’Hollaren1 ,  John Knapp1 ,  Codrut Radoiu1 ,  Aron Liaw1,2 ,  Nivedita Dhar2,3*
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1 Department of Urology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
2 John D. Dingell VA Medical Center, Detroit, Michigan, United States of America
3 Detroit Medical Center, Detroit, Michigan, United States of America
Bladder 2024 , 11(2), e21200010; https://doi.org/10.14440/bladder.2024.0017
Submitted: 17 July 2024 | Revised: 27 August 2024 | Accepted: 5 September 2024 | Published: 3 October 2024
© 2024 by the Bladder published by POL Scientific. Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Introduction: COVID-19-associated cystitis (CAC) may arise following a COVID-19 infection and is characterized by the development of novel or worsening overactive bladder (OAB). CAC is possibly associated with bladder mucosal damage and the release of pro-inflammatory cytokines, resulting in inflammation and fibrosis of the bladder wall. Amniotic membrane (AM) has been shown to possess anti-inflammatory and anti-fibrotic properties and might potentially be beneficial for CAC. This study investigated the safety and efficacy of bladder injections of AM in CAC patients with resistant OAB symptoms. Methods: Five CAC patients, with an average age of 73 ± 1.0 years and a median disease duration of 2.4 years, received intra-detrusor injections of 100 mg micronized AM under general anesthesia and were followed for 20 weeks. Key urodynamic measures (involuntary detrusor contraction and maximum cystometric capacity) were determined to evaluate treatment response. Quality of life (QOL) was assessed using the OAB assessment tool, and safety was analyzed. Results: All five patients showed improved urodynamic bladder function and significantly improved QOL improvements. The improvement was evident from 4 weeks post-treatment and sustained until 12 weeks. Symptoms re-surged at 20 weeks. No safety concerns arose during the study. Conclusion: The observed improvements in symptom scores and bladder volume parameters highlighted the promise of AM bladder injections as a viable intervention for CAC patients with refractory OAB symptoms. Comprehensive studies are needed to validate its therapeutic potential, and treatment protocol refinement is warranted to address the observed reduction in efficacy over time.

Keywords
Amniotic bladder therapy
Bladder function
COVID-19
COVID-19-associated cystitis
Micronized amniotic membrane
Overactive bladder
Pro-inflammatory cytokines
Urodynamic study
Viral cystitis
Funding
None.
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Conflict of interest
The authors declare no conflicts of interest. The product was not donated by the Company.
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