O-Shot® [Orchid Shot™] Procedure Variations to Heal Hard-to-Treat Gynecological Problems

Introduction

What’s In this Report, How to Use It, and Why I Wrote It.

I wrote this report for one reason: to help you, a physician, take better care of women suffering from difficult-to-treat gynecological problems.

This report does not describe how to cure every woman of every disease. On the contrary, women are suffering from problems for which I have not one new suggestion. For example, there is nothing new here about how to treat ovarian cancer; but you will find a section about how to treat women who suffer from vaginal dryness and the secondary dyspareunia that often plagues women after treatment for breast cancer.

Also, some women who suffer from problems for which I offer solutions will not respond at all to the therapies I suggest; you may implement all of the suggested strategies for a particular problem and still see no improvement in your patient. I know of no therapies in medicine that work perfectly and offer no risk of negative sequelae; the strategies offered in this report are no exception and do not “work” every time.

We never say that antibiotics “don’t work,” even though some people will die from sepsis even when treated with antibiotics; antibiotics do work, but they do not work every time. With a new idea, however, this same standard does not apply. Often both patients and physicians will say, after only one person does not see the benefit, “See, it doesn’t work.”

As with every other therapy in medicine, part of the art of using the therapies described in this report is knowing who may benefit and who may not and using this knowledge to carefully choose who to treat.

On the other hand, most women who are helped by you when you offer the strategies described in this report will consider you to be nothing short of a miracle worker. Let me explain why they will think so.

“Chronic” Means “Manage,” Not “Cure”

Thirty years ago, in 1986, while sitting in class at the University of Alabama School of Medicine—that was the moment that I truly comprehended the word “chronic.”

I knew that physicians could not cure all diseases, but when I learned the word chronic and contemplated the gravity of its meaning, I felt deflated. When we label a disease as chronic, we acknowledge that this problem that plagues my patient will never go away—never. The patient and I will cease seriously looking for a cure. Instead, we will agree that since this disease will never go away, our goal will only be to minimize progression and suffering.

So, after labeling a disease as chronic, we quit trying to cure.

I hate the word “chronic.”

People who suffer from chronic conditions often sacrifice hope to the god of despair and start bowing to the god of anger and learned helplessness.

So, if I show you how to actually cure even a small fraction of the disease that you and your patients now consider chronic, then those women will recover the same awe for medicine, yes, even the idea of the miracle of medicine, that people held in the days of the discovery of penicillin and rabies vaccination.

Your Secret Ambition

It may help if you consciously acknowledge something right now: you went into medicine because you want to do miracles.

It’s OK.

You and I can talk about it. You don’t have to be embarrassed. Leonardo da Vinci once said, “I want to do miracles.”

If you only wanted to make money, you could have put one-half the effort into real estate, and you would already have over three times the money that you have now. You went into medicine, not for money, but because you want to do miracles—that's a good thing. And, compared to what the physicians of two hundred years ago could do, you already do miracles.

But, you still have this nagging word, "chronic," which describes the conditions for which you still are left frustrated, the conditions that remind you that sometimes you cannot do miracles. Chronic conditions sometimes make you feel helpless—your patient still suffers even after you do your best using all that you know.

In this report, I will show you a few places where you can make a woman’s chronic problem go away. Then, you will be rewarded with the prize that enticed you to medicine: the heartfelt “thank you” from someone whom you prompted a miracle.

So, how is this possible?

How you are About to Do Miracles that You Did Not Think Possible

So, why am I so sure of this promise that you will do miracles that you cannot now do?

Imagine that you are a physician in the days before antibiotics, then after this whole new concept, “antibiotics,” is introduced to you, now you can do things that before you did not think possible. Or imagine that you are a physician in the days before Louis Pasteur and his rabies vaccine. The whole idea of vaccines was new. But, after the idea is introduced, suddenly, you can do things that neither you nor your patients thought possible. Then, after the new idea becomes part of your practice, your job is not done; the job then becomes to take this new idea (“antibiotics” or “vaccines”) and develop it in an infinite number of ways: Where else can it be used. What dosages and routes of delivery work best? For whom does it work, and where does it do more harm than good?

First, there is a new idea. Then, there become lifetimes of investigation about the infinite variety of applications of the idea. First, there comes the idea of vaccines; then, for over a century, physicians have studied new ways to use and make vaccines. First comes the idea of antibiotics; then, we have spent over a century so far discovering and investigating the uses of antibiotics. First, there comes the idea of beta-blockers; then, so far, physicians have published over fifty thousand papers (listed on PubMed) about how to use beta-blockers for congestive heart failure.

Now, most physicians are just now learning the new idea of using regenerative therapies to improve tissue health and thereby cure disease—specifically using platelet-rich plasma (PRP) for this purpose. Over the past two decades (a relatively short time), there has been a mostly quiet revolution in medicine as physicians and patients have discovered that by using cellular therapies, some problems can be treated in ways that until now we considered impossible. Now comes the exploration of the infinite number of ways this new idea, regenerative therapy, can be used.

Until 2010, PRP was mostly talked about in the arena of wound care or post-op recovery of the avascular, hard-to-heal tissues of orthopedics and dentistry.

Now, those ideas about wound healing are being applied to tissue that has not been wounded; and the results have sometimes been amazing. More specifically, by using the same ideas used to heal wounds where there is no wound but where there is unhealthy tissue, there can be remodeling of the unhealthy tissue with new collagen and neovascularization and neurogenesis and a resultant healthier tissue and healing of disease—some of which was thought to be chronically diseased.

Only a decade ago, in the year 2010, I was the first to use these ideas and inject the penis and the clitoral-urethral complex with PRP. Since 2010, largely because of our group, the Cellular Medicine Association, the idea of using PRP for urological and gynecological diseases has developed and become more widely used. Over the past decade, I personally trained over 5,000 doctors in over 50 countries regarding the use of PRP for gynecology and urology. Hundreds of the physicians (and physician extenders) have taught other physicians and have come back to teach me what they have observed.

Also, though I have published studies, hundreds of papers have now been published regarding the use of PRP for urological and gynecological problems.

Where is the Finish Line?

Do we need more studies?

Of course, we do!

If you search the terms “beta-blocker” and “congestive heart failure” on PubMed, you will find over 50,000 results. But, we were using beta-blockers for congestive heart failure long before we reached the 50,000 mark. Now, we have this new idea of using PRP to restore tissue to health—yes, to cure some urological and gynecological diseases.

I not only acknowledge that we need more research, I implore you to help us do that research. But, at what point do you decide that you will make this idea available as a help to the next woman who visits you in your office?

As with every new idea, the point at which you pick it up as a tool and start using it will depend upon all of the following: (1) How much of what’s known about the basic science have you read? (2) Have you learned the physical skills needed to use the material (PRP cannot be injected haphazardly and work optimally). (3) Have you learned of the technology approved by the FDA for the preparation of PRP for injection back into the body and made this technology easy accessible in your office? (4) Are you keeping up with ongoing research and the changes in FDA policies and implementing such knowledge in your practice?

In short, are you learning about and keeping up in the area of the regenerative possibilities of PRP, or is your brain attacking the new idea the way an antibody attacks a foreign protein?

When the idea of antibiotics for peptic ulcers was introduced, physicians were slow to accept the idea because they already had a way to treat ulcers—surgery and Tagamet. The hindrance to knowledge is not ignorance; it’s the illusion of already knowing.

I hope, for the benefit of your patients and for your own soul satisfaction, you will use this report as a way to jump into this new arena of medicine.

What I offer you in this report is a summary of areas where I think we are at least near the place, if not at the place, where the benefit to risk ratio of using PRP for some conditions warrants that the strategy is used.

You may disagree. That’s OK. But, if I can give you the logic and the science behind the strategy of PRP done in a specific way for certain chronic or hard-to-treat conditions, if I can tell you why after looking at the research, doing some the research, if after treating thousands of patients and talking to physicians who have collectively treated hundreds of thousands of patients, if I can tell you why after all of this I think that PRP, now, should be used for several conditions in carefully selected patients, then I have done my job. Then, I hope that even if you do not agree with me about everything (smart people never agree about everything), I hope you will at least consider helping us move the science forward for the benefit of the women who now live with the word “chronic” and the resultant suffering both physically and psychologically.

The Seldom Discussed Difference in the Definitions of Disease Between Men & Women

To meet the definition of “sexual dysfunction,” a woman must be suffering from both a physical problem and secondary psychological distress.

If a man has erectile dysfunction, he has erectile dysfunction whether or not it bothers him psychologically. But, if a woman has dyspareunia or anorgasmia, she is not considered to suffer with sexual dysfunction unless she is psychologically bothered by the condition. Even with this stricter definition for women compared with men, around 30-40% of women suffer from sexual dysfunction CHRONICALLY!

What you’re doing doesn’t work all the time. So, you tell women to use a vibrator or KY jelly or go see a sex therapist to learn how to have good sex even though it hurts or even though she seldom, if ever, has an orgasm. Or, you tell her to use her steroid cream every day of the rest of her life or take her psychotropic drug for the rest of her life because her lichen sclerosis or interstitial cystitis will never go away.

But, after you read this report, I hope that BECAUSE YOU ARE NOW EXPLORING A WHOLE NEW CLASS OF TREATMENTS, you will realize that SOME (not all) of the women who suffer chronically may be able to know complete relief.

Again, cellular therapies are NOT magic and do not cure everyone of everything. Einstein said, “Either everything is a miracle, or nothing is a miracle.” I’m not sure if your patients will call the results they see when you use the ideas in this report a “miracle,” but they will definitely tell you "thank you."

And you will drive home from work to your family that you see less than you would like, and will be glad that you studied medicine instead of becoming a stockbroker.

Why You Will Worry Less

One wonderful thing about PRP is that it has proven to be very safe. Millions of PRP procedures are done every year. Regen alone sells more than a million kits per year, and there are a dozen other manufacturers of PRP kits. And, yet the number of serious sequelae reported in the literature is less than a dozen, and even these are reported in cases where unknown hyaluronic acid fillers were also used.

So, though PRP used for the indications I will show you in this report does not work one hundred percent of the time, you won’t lose sleep worrying about serious sequelae after doing these procedures.

There has been some confusion about the FDA’s stance regarding PRP, but the FDA has been very clear about its policy. The FDA regulates drugs and devices. They do not regulate urine, skin, hair, or blood products, and they do not regulate PRP. When you transfer hair from one part of the scalp to another, the hair belongs to the patient and is not regulated by the FDA. When you draw a patient’s blood, even if you fractionate it with a centrifuge and then give it back to the patient, the blood or the fraction (PRP) belongs to the patient and is not regulated by the FDA

The concepts that make PRP acceptable to use without FDA oversight include the following:

  1. PRP is autologous; blood is taken from a person, then a part of that blood is given back to the same person.
  2. PRP is homologous; platelets release growth factors that improve the health of tissue leading to repair, neovascularization, collagen production, and neurogenesis. When we inject PRP in the procedures reported here, we employ the PRP to do what it normally does. That makes it homologous.
  3. PRP is minimally manipulated. If you take adipocytes and put them through a multi-step process to isolate stem cells, that is not minimal manipulation; you have now made a drug. And, drugs require an IRB for use in a new indication. If you take hair or skin and move it from one part of the body to the other, you have not changed the nature of the hair or skin; you minimally manipulated it. If you draw blood and you simply take a fraction of that blood and give it back to the patient, you have also minimally manipulated; you have not made a drug.

Moreover, the FDA confirmed the above reasoning by specifically stating that they do not regulate PRP.

What You’ll Find in This Report

In this report, you will find specific ideas about how to treat all of the following:

Stress urinary incontinence in women who do not want surgery and not respond to Kegels.

Post-mid-urethral sling sexual dysfunction

Lichen sclerosus

Post mesh pain

Interstitial cystitis

Post-episiotomy pain or bleeding

Vaginismus

Pelvic floor tenderness

Anorgasmia

Decreased libido

Of course, you have treatments for all of these conditions already; none of those current treatments in your toolbox go away. But, by adding PRP to your toolbox, as you are about to learn, you may see some very troubling conditions simply go away or greatly improve after years of chronic suffering.

How to Get the Most From This Report

This report does not replace proper training. Those physicians (and physician extenders) who already offer the O-Shot® procedures will find this report to be a helpful review and adjunct to their training.

Those physicians who are considering beginning training with PRP will find this review to be a helpful introduction to the ideas and the techniques and a way to decide to pursue further exploration of the ideas both in training and in well-designed studies.

Only those who have been trained and tested by the Cellular Medicine Association are licensed to use the word “O-Shot®” for advertising the procedures. This is our attempt to require an agreement regarding standards of care where a procedure is done with a blood product that is. not regulated by the FDA.

In comparison with PRP, no board regulates the injection of Botox and hyaluronic acid fillers. The FDA does regulate these products because they are drugs, but there is huge variability in the way they are injected, and there is no medical board that regulates these variations. Worrying that the same variability that is seen with the injection of fillers in the face, if applied to the injection of the genitalia, would result in unacceptable results, the licensees of the Cellular Medicine Association agree to follow guidelines regarding the procedure of PRP preparation and injection. These methods have evolved over the past decade as more research and experience and the number of members has grown.

I hope you will use this experience to the benefit of your patients.

A Few Words About Who I Am and My Role In Your Life

There were at least 3 things that led to the perfect storm that led to the initial design of the O-Shot® procedure:

I.

In January 2000, I started doing clinical trials and offering micromanagement of hormone replacement for women as part of my internal medicine practice. Over the following years, after doing hormone replacement for over three thousand women, I developed a sense of the problems and the usual solutions for women’s sexual dysfunction.

II.

While doing hormone replacement to help the symptoms of menopause, including weight gain, I noticed that some women would want to gain their weight back (even to become overweight again) because when they lost weight in the face, their face looked older. Before JUVEDERM® was approved in the US, I started offering Restylane as a way to restore the youthful shape (that collapsed with weight loss) as part of the way I would encourage women who lost weight to continue their weight loss and to maintain their healthier weight.

III.

I also ran a hospital-based wound care center and developed some expertise in the area of wound healing and tissue growth.

So, with these three interests (women’s hormones and sexual health, cosmetic medicine, and wound healing) when PRP became a part of the conversation for facial cosmetics in the year 2009, I became aware of the technology and immediately wondered if the idea might apply to male and female sexual dysfunction.

So, I started by developing the Vampire Facelift® and the Vampire Breast Lift® as a way to improve facial cosmetics and to study the effects of PRP on tissue; then, I took what I learned there and applied it to the genitalia to design the O-shot® (Orchid Shot™) and the P-Shot® (Priapus Shot®).

Soon after developing the above-mentioned procedures, I teamed up with the members of the Cellular Medicine Association (CMA). We then spent the past decade publishing and teaching ideas regarding using cellular therapies to improve tissue and therefore attenuate or cure disease. Without the brilliance and the bravery of the members of the CMA, the development of the use of PRP for urology and gynecology would be nowhere near what it is now.

Much of what I describe in this report was taught to me by the members of the CMA. Our members publish research, and we meet weekly to share our observations and the research of others, and many of our members offer hands-on training. Here’s where you can learn more about how our organization so that we can support you in your efforts to help your patients to better health using cellular therapies: CellularMedicineAssociation.org

Here are other places where you can find help:

If you are already trained to offer the O-Shot® procedure, you have available to you hundreds of videos and much written (that can be translated into any language with a click of a button) within our members-only website. Here's where to change your password (if needed):
CellularMedicineAssociation.org/password
Here's where to log in to the members-only area (use the search box on the side to find videos and written descriptions that expand what is introduced in this report):
OShot.info/members/wp-login.php 

Where you can learn more about training to become licensed to offer the O-Shot® procedure (with all its variations) to your patients
Oshot.com/members

Where you can learn more about training to offer the Vampire Facelift® procedure.
VampireFacelift.com/physicians

Where you can learn more about training to offer the Priapus Shot® procedure to help your men patients with erectile dysfunction, Peyronie’s disease, BXO, and recovery from prostate surgery (penile rehabilitation).
PriapusShot.com/physicians

Where you can find our teachers of multiple specialties in countries scattered around the globe.
CellularMedicineAssocation.org/teachers/directory

Final Words

My goal is to be a perfectly clean pipe that brings to you the best of the ideas that are being developed and researched in the arena of cellular therapies for the purpose of healing women and men. I respect you for making it thus far in this report and hope that (when I deliver in this report the help that I promised) this will be the beginning of our friendship and collaboration. I hope that after you study this report and think about the ideas therein, you will reach out to me and let me know how they helped you and your patients. I hate to see women struggle with gynecological problems, and I love hearing good reports after someone studies our methods and helps a woman to better health and deeper relations. Consider me on call to help clarify or collaborate.

You can email me at DrRunels@Runels.com.

Or, you can text my personal cell phone at 251-648-7704

Hopefully, you will consider it fair that if you have a question that is answered by one of the books I have written, research we have published, or by one of my websites with instructional videos, I refer you to the appropriate material. But, there’s so much still to be learned, and our ideas need more thought and development I’d love to discuss whatever seems helpful to you, even sponsoring research that you may wish to do.

Very best wishes as you work to help your patients find their best health.

Sincerely yours,

Charles

Charles Runels, MD

1-888-920-5311
DrRunels@Runels.com
CellularMedicineAssociation.org

Next hands-on classes with live models<--

Application for Online training for the O-Shot® and other procedures<--

Section 2. Mid-Urethral Sling Induced Sexual Dysfunction

From Leaking Urethra to Damaged Prostate

Most women who undergo a mid-urethral sling (MUS) placement will see an improve sexual function, but 1 in 11 women will suffer a decrease in sexual pleasure after the procedure.

Midurethal sling: Better sex for most women; but 1 in 11 suffers more?

One in 11 suffers more.

So, to better understand the reason for this unwanted result (of decreased sexual pleasure in 1 in 11 women who undergo MUS), Guadet et al. performed mid-urethral slings on cadavers and then sectioned the area to visualize the affected tissue. They reported their results in the Journal of Sexual Medicine in 2018 as follows:

“MUS placement interrupts tissue with glandular, vascular, and neuronal structures within the periurethral space adjacent to the anterior vaginal wall. Disruption of the prostatic glandular tissue and neurovascular structures may be a root cause of orgasmic dysfunction and diminished sexual satisfaction evident in women following MUS implantation.

Recovering Function (or Preventing Dysfunction) in Regards to MUS

Considering the previous description, to correct or prevent the problem, where would you inject a material which increases blood flow, grows nerves and collagen, improves the health of glandular tissue, and has never been reported to form a granuloma or neoplasia?

Also, consider that the material you will inject is aqueous, so it will hydrodissect along the tissue planes, taking the path of least resistance as if you were hydrodissecting with saline. This means you would not need multiple injections since you could use the pressure gradient generated by your syringe to spread the material.

Now, look at the following diagram, the same one we used to describe (in Section 1) what could be the best of the currently published options for the placement of the needle for the injection of PRP for the treatment of stress urinary incontinence (the O-Shot® procedure).

Then take another look at the photograph of the placement of the needle for the O-Shot® procedure:

Now you can see that our O-Shot® procedure is designed to repair exactly where these brilliant investigators documented that the neurovascular damage from a MUS occurs. (Application for further training in the O-Shot® procedure can be found at OShot.info/members (click), this description does not constitute training or license to use the name “O-Shot,” which is protected by the US Patent & Trademark office for license to only those approved by the Cellular Medicine Association.

My Third Female-Ejaculation Experience, Which Leads to the O-Shot® Procedure

In 1984, while in medical school, one of our professors said to the class, “I do not want anyone to finish at this medical school and still think that female ejaculation is not a real phenomenon.”

Then, he showed us a video of a woman masturbating until she ejaculated.

Watching the video, I thought, “Looks like an interesting party trick; but of what practical benefit does that serve except the knowledge that the female body can ejaculate.”

Years later, a lover demonstrated to me that she could bring herself to masturbation with ejaculation. I still found the phenomenon interesting but not warranting much attention.

Then, it happened.

While I was making love to a woman, she unexpectedly ejaculated for the first time; and, unlike what I had witnessed with the previous two demonstrations (ejaculation while masturbating) when she ejaculated during our lovemaking, not only could I almost feel the deep, soul-shattering depth of her orgasm, but also her demeanor afterward reflected that of a man after ejaculation with calmness, satisfied bliss, and a wanting to connect with me emotionally like I had never witnessed with this woman—perhaps with any woman.

Finally, I took notice.

Up until then, the female orgasms that I had witnessed were associated with women showing varying degrees of pleasure during the orgasm, followed by increased energy and increased hunger for more sex and more orgasms. But, observing my third female ejaculation, the woman afterward showed calmness and peace and greatly decreased energy and complete satisfaction; more importantly, she seemed to drop invisible walls and swing open a wide path from her soul to mine.

I concede that my description of female ejaculation does not provide a scientific-objective explanation of what happened; but hopefully, you will forgive the description when you consider that when I find world-renowned experts in female sexuality and ask them to describe it to me in scientific-objective words, what happens when a woman experiences an orgasm of any kind, I can see their frustration as they give what we both know to be a relatively superficial answer to a profoundly important phenomenon.

So, since there is no good scientific explanation of the frequent orgasms of usual lovemaking (in comparison with a soul-shaking orgasm where the woman sobs, ejaculates and melts her soul into yours), I hope that you will pardon my use of a subjective description where no objective measure exists. Something happens to more easily facilitate a soul connection between a woman and her lover (and maybe even her GOD) when she experiences an ejaculatory orgasm.

After experiencing for the first time this phenomenon of female ejaculatory orgasm during lovemaking, I decided to pay more attention; I began reading all the popular books, the textbooks, and the research that I could find regarding female ejaculation. And, I began learning more about my lover (and subsequent lovers) about how to reproduce and enhance the experience of the female ejaculatory orgasm.

William Osler once told his medical students that if he asked them how long it takes for the fingernail to grow one length, most of them would not give it a second thought; some of them would read about it; and a few of them would grab a silver nitrate stick, make a mark on their proximal thumbnail with the stick, and then measure how long it took for the mark to grow to the end of the finger.

It was in the spirit of the third medical student described by Dr. Olser that I read the books and the research for the next ten-plus years and then took that reading to the bedroom. Over more than a decade, I developed my own ideas about female ejaculation. I even published an online course for men about how to help their female lover to a complete and profound ejaculatory orgasm and have helped thousands of couples with that course.

I tell you about my interest in female ejaculation for only one purpose: to show you that the study of female ejaculation combined with my work providing hormone replacement and menopausal care for over 3,000 women is what set the stage for me to design the O-Shot® procedure.

Then, in early 2010, I was first introduced to the idea of PRP and its possibilities for cosmetic use in the face. Because the stage was set, one of the ideas that occurred to me regarding PRP was to inject it near the distal urethra in the area of the Skene’s glands (female prostate) to see if it would enhance the female ejaculatory orgasm. During this time, I had already developed the P-Shot® and injected my own corpus cavernosi (penis) multiple times, so it seemed reasonable also to inject the female corpus cavernosi and periurethral area as well.

The best I can tell, I was the first to inject (2010) the female periurethral area with PRP.

First, I injected my lover; I had taught her to have an ejaculatory orgasm and wanted to see if things would improve. Afterward, her ejaculatory orgasms grew consistently higher on the Richter scale.

I thought maybe her results were just a placebo effect. Then, knowing that PRP has been shown in multiple studies to remodel scar tissue into a more healthy state, I injected a woman’s periurethral and clitoral area who had been physically abused by her x-husband—leaving her with severe dyspareunia and anorgasmia even after seeing multiple gynecologists.

So, she received the second O-Shot® procedure.

Afterward, not only did her dyspareunia resolve, but also she reported to me that she was able to start running again because her urinary incontinence went away.

I thought, “Why didn’t I think of that?!”

In the process of injecting in the area of the Skene’s glands (or female prostate), I had inadvertently chosen a place that would help urinary incontinence and improve the nerves associated with sexual function and micturition.

Since then, we (members of the Cellular Medicine Association) have found that injecting more proximal to the bladder does not affect the entire urethra as significantly with resultantly less improvement for both urinary incontinence and for sex.

So, my process of designing the place to put the PRP to improve ejaculatory orgasm inadvertently resulted in placing the PRP where it would best help those suffering from urinary incontinence or with sexual dysfunction after a sling.

Summary

  • Most women see an improvement in sexual function after a mid-urethral sling.
  • One in 11 women sees a decrease in sexual function after a sling.
  • Cadaver studies showed that the nerves, Skene’s glands, and blood flow disrupted by the placement of a MUS lie exactly where the PRP is placed when doing the O-Shot® procedure.
  • PRP is aqueous and therefore requires a minimum of injection points if the needle lumen is put into the proper tissue plane to affect best the tissue that needs repair.
  • Meticulous placement of the PRP for improvement of sex after MUS placement is critical to the success of the procedure.
  • Reading this report does not qualify anyone to do an O-Shot® procedure; many critical nuances are beyond the scope of this report.
  • Application for training in the O-Shot® procedure can be found at OShot.info/members.

References

  1. Jang HC, Jeon JH, Kim DY. Changes in Sexual Function after the Midurethral Sling Procedure for Stress Urinary Incontinence: Long-term Follow-up. Int Neurourol J. 2010;14(3):170. doi:10.5213/inj.2010.14.3.170
  2. Gaudet D, Clohosey DG, Hannan JL, et al. 249 Midurethral sling placement disrupts periurethral neurovascular and glandular structures near anterior vaginal wall: Potential role in female sexual dysfunction. The Journal of Sexual Medicine. 2018;15(7):S221-S222. doi:10.1016/j.jsxm.2018.04.214
  3. Runels C. A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma (PRP) for the Treatment of Female Sexual Dysfunction. J Women’s Health Care. 2014;03(04). doi:10.4172/2167-0420.1000169
  4. Gaudet D, Clohosey DG, Hannan JL, et al. 249 Midurethral sling placement disrupts periurethral neurovascular and glandular structures near anterior vaginal wall: Potential role in female sexual dysfunction. The Journal of Sexual Medicine. 2018;15(7):S221-S222. doi:10.1016/j.jsxm.2018.04.214
  5. Rodriguez FD, Camacho A, Bordes SJ, Gardner B, Levin RJ, Tubbs RS. Female ejaculation: An update on anatomy, history, and controversies. Clin Anat. 2021;34(1):103-107. doi:10.1002/ca.23654
  6. Pollen JJ, Dreilinger A. Immunohistochemical identification of prostatic acid phosphatase and prostate specific antigen in female periurethral glands.
    Urology. 1984;23(3):303-304. doi:10.1016/S0090-4295(84)90053-0
  7. Korda JB, Goldstein SW, Sommer F. SEXUAL MEDICINE HISTORY: The History of Female Ejaculation. The Journal of Sexual Medicine. 2010;7(5):1965-1975. doi:10.1111/j.1743-6109.2010.01720.x
  8. Tomalty D, Giovannetti O, Hannan J, et al. Should We Call It a Prostate? A Review of the Female Periurethral Glandular Tissue Morphology, Histochemistry, Nomenclature, and Role in Iatrogenic Sexual Dysfunction. Sexual Medicine Reviews. 2022;0(0). doi:10.1016/j.sxmr.2021.12.002
  9. Dietrich W, Susani M, Stifter L, Haitel A. The Human Female Prostate—Immunohistochemical Study with Prostate‐Specific Antigen, Prostate‐Specific Alkaline Phosphatase, and Androgen Receptor and 3‐D Remodeling. The Journal of Sexual Medicine. 2011;8(10):2816-2821. doi:10.1111/j.1743-6109.2011.02408.x
  10. Zavia M. Ultrastructure of the normal adult human female prostate gland (Skene’s gland). :12.
  11. Alves R, Grimalt R. A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification. Skin Appendage Disord. 2018;4(1):18-24. doi:10.1159/000477353
  12. Gawdat H, El-Hadidy YA, Allam RSHM, Abdelkader HA. Autologous platelet-rich plasma “fluid” versus “gel” form in combination with fractional CO2 laser in the treatment of atrophic acne scars: a split-face randomized clinical trial. Journal of Dermatological Treatment. 2022;0(ja):1-31. doi:10.1080/09546634.2022.2067816
  13. Charles-de-Sá L, Gontijo-de-Amorim NF, Takiya CM, et al. Effect of Use of Platelet-Rich Plasma (PRP) in Skin with Intrinsic Aging Process. Aesthet Surg J. 2018;38(3):321-328. doi:10.1093/asj/sjx137
  14. Eichler C, Üner J, Thangarajah F, et al. Platelet-rich plasma (PRP) in oncological patients: long-term oncological outcome analysis of the treatment of subcutaneous venous access device scars in 89 breast cancer patients. Arch Gynecol Obstet. Published online April 4, 2022. doi:10.1007/s00404-022-06416-4
  15. Number 5 SV 24. Platelet-Rich Plasma (PRP): Current Applications in Dermatology. Accessed August 26, 2021. https://www.skintherapyletter.com/dermatology/platelet-rich-plasma-prp/
  16. Sánchez M, Anitua E, Delgado D, et al. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opinion on Biological Therapy. 2017;17(2):197-212. doi:10.1080/14712598.2017.1259409

Section 1. Urinary Incontinence in Women: A New Way to Avoid Surgery—Why & How it Works

 

The Overlying Most Important Principle in This Report

What diseases could you treat If you had a treatment that could propagate new blood flow, grow nerves, calm the autoimmune response, fight infection, regrow collagen, and enhance glandular function? The answer to that question gives you an idea about the possibilities with platelet-rich plasma (PRP). That idea (together with the current research and the experience of more than three thousand doctors over a decade) is the theme behind the strategies discussed in this report.

Thinking about how antibiotics work helps you consider what conditions may be helped by antibiotics; this consideration of which conditions my be helped and which may not be helped by antibiotics happens so automatically that we may not consciously acknowledge the process.

For example, we would not think about antibiotics for the primary treatment of uterine fibroids because fibroids are not primarily caused by infection; antibiotics only treat infection. But, with a new therapy that is not as well known or understood, we may not be clear about the mechanism of the treatment; therefore, there can be confusion regarding which disease processes the new therapy may be of benefit—leading to inappropriate use and less than expected results.

But, if a new treatment is considered (as with old standards of care) only when the pathology of the disease makes the use of the new therapy appropriate, results will be optimal, and we can avoid the proverbial throwing out the baby with the bathwater when the new therapy “doesn’t work” when we use the new therapy for a problem for which it would not be likely to help.

With this general idea about the relation of the mechanism of therapy and pathology of disease in mind, consider that (except for secondary results, which we will discuss in later sections) the only conditions that PRP may help are those in which strategic injection into tissue will improve the disease by improving the health of the tissue: neovascularization, neurogenesis, collagen production, improvement of glandular function, attenuation of autoimmune processes, fighting infection (all of which PRP has been documented to do).

Striated Urogenital Sphincter Grows Weaker

In considering where improved tissue health might improve stress urinary incontinence in women, first consider the striated component of the urogenital sphincter—it accounts for one-third of the resting urethral closing pressure Delancey2017

Here's my sketch of the striated muscle component—taken from diagrams published by Delancey and others:

Striated Urogenital Sphincter
Striated Urogenital Sphincter

The striated urogenital sphincter completely encompasses the urethra at level one, while, at level three, it encompasses both the urethra and the vagina.

Beneath the striated urogenital sphincter lies smooth muscle that runs longitudinally, which also contributes to the closing pressure.

Just like the striated muscle of the bicep or the thigh, the number of muscle fibers in the urogenital sphincter decreases with age. Also, the number of nerves innervating the sphincter decreases with age.

To complicate matters, even more, the function of the urogenital sphincter is known to be damaged by childbirth.

Does the decrease in innervation lead to the decrease in muscle fibers, or is the decrease in muscle and the decrease in nerves two independently evolving conditions? And does blood flow play a role? I could find no clear answer to these questions. But, whatever your answer to those questions, they prompt corollary ideas such as that the effect of voluntary Kegels may be attenuated by the decreased innervation of the striated muscle (explaining the lack of effectiveness of Kegels in some women).

Treatment Strategies Based on the Functional Anatomy of the Sphincter

Activation of the striated muscle of the sphincter independently of the patient’s volition or the innervation of the muscle (for example, with an Emsella® magnet) would possibly create more contraction than would be possible even with heroic efforts by the woman. This super activation would cause a strengthening of the striated sphincter and an increase in closing pressure.

Also, the sports-medicine literature offers robust support for the idea of using PRP to restore damaged or atrophic muscle. And multiple papers demonstrate neurogenesis propagated by the injection of PRP.

If we propagated neurogenesis and muscle fiber restoration with PRP, then that might be synergistic with Kegels or with magnet therapy or with surgery (if needed).

The Urethral Wall Acts Like a Penis

The urethra wall (not the surrounding tissue, the urethra itself) carries a vascular plexus with AV anastomoses; blood flow can be directed into or away from these venues to inflate or deflate them; so it demonstrates tumescence similar to that of the penis. But in the female urethra, tumescence contributes to the closing pressure of the urethra (not erectile function, as in the man).

Hormones are known to affect this tumescence-like function of the urethra. But, what are hormones but messengers to tell cells what to do? Messages-to-the-cells is exactly what happens when the cells of the urethral wall are exposed to the small peptide chains released from platelets.

PRP was shown in a recent double-blind placebo-controlled study to improve the erectile function of the penis. Since PRP helps with neovascularization in general and has been shown to improve erectile function, it seems logical that PRP may also, when injected into the urethral wall, improve the tumescent function of the urethral wall and the closing pressure of the urethra—resulting in a decrease or resolution of urinary incontinence.

Longitudinal Smooth Muscle of the Urethra

The longitudinal smooth muscle of the urethra also contributes to the closing pressure. The smooth muscle cannot be contracted by either volition or by a magnet, so neither would help strengthen the smooth muscle component of the female urinary sphincter. But, as we have documented with the studies in our bibliography, PRP has been shown to revive muscle fibers. So, injection of the urethral smooth muscle may also account for some of the benefits of PRP seen when it is injected into the periurethral area.

And of course, such benefits of PRP may also be of help post-op from a mid-urethral sling placement. One study documented that the nerves and blood vessels between the anterior vaginal wall and the urethra are damaged by the surgical placement of a mid-urethral sling; and we have just discussed how PRP can repair nerves and blood vessels.

Urge Incontinence

Urge incontinence, multifactorial and often seen in combination with stress incontinence, can be partly secondary to peripheral nerve involvement as previously mentioned. And research supports the idea that PRP may improve the function of those nerves resulting in an improvement in urge incontinence—if the PRP should be deposited in the proper place.

PRP Injection Strategies for the Treatment of Urinary Incontinence

So, it makes sense that all of the above-mentioned ideas, if applied to the urinary sphincter in a female, might show synergistic benefits. Indeed, multiple papers do show that injection of PRP into the periurethral area or into the urethral wall improves stress urinary incontinence.

In these published papers showing benefits for stress urinary incontinence with the injection of PRP, multiple techniques have been used; so, let’s think about some of those techniques while keeping the functional anatomy in mind—looking for the best possible strategy (at least with our present knowledge).

The O-Shot® Procedure for Urinary Incontinence

With our O-Shot® procedure, we usually do two injections, one of which goes into the vaginal wall, hydro-dissecting the entire area.

Four CCs is enough to fill the whole space between the urethra and the vaginal wall and include the urethral wall—if you put the needle where it to needs to go.

Just like with an IV, there's variability, both in technique and with the skill of the person doing the procedure; but if you can put the needle where it belongs, you should be able to put PRP in the areas we’ve described.

The following is a snapshot from one of our instructional videos showing one of the two injections the way we teach the O-Shot® procedure for SUI. By injecting the actual anterior vaginal wall within a few millimeters of the hymenal remnant, you avoid the pain fibers within heart's line, and you're able to fill both the space between urethra and vagina and affect muscle, blood flow, and nerves. This can be done pain-free or near pain-free using the proper technique and only a topical cream for anesthesia.

This method, when done properly, is called the O-Shot® procedure. The procedure can be done in the office using the person’s own blood and without pain in most cases.

I trademarked the term “O-Shot” to prevent variability of techniques with the associated variability of results being pushed upon women. All of the licensed providers of the O-Shot® procedure agree to follow a standard protocol with variations based on disease process. All licensed providers also agree only to use devices to prepare the PRP that has been approved by the FDA for the preparation of PRP to go back into the body. Our licensees are tested and are subject to losing the license to use the name “O-Shot®” in advertising if they fail to follow our standards.

Physicians can apply to receive more detailed instructions and to be licensed to perform the O-Shot® procedure here—>: OShot.com/physicians<—

Example of Another Technique for Curing Urinary Incontinence with PRP

Another group demonstrated (I think in a very brilliant and useful study) the resolution of urinary incontinence with the injection of PRP directly into the urethral wall—in women with objectively-demonstrated severe incontinence.

But, in their method, they report that the procedure was so painful that the subjects had to receive the urethral sphincter injection under intravenous general anesthesia in the operating room.

The following photograph illustrates the injection points:

This is NOT the O-Shot® procedure; the O-Shot® procedure is a method of choosing the proper patient, properly preparing the PRP, and injecting the PRP with the agreed-upon technique after using local anesthesia that gives the best chance of an in-office, pain-free procedure.

But, though these investigators did something other than an O-Shot® procedure, they did help the mission of finding a way to cure or improve female urinary incontinence by demonstrating the possibility of improving the health and function of the urinary sphincter by using a functional-anatomy-based, strategic injection of PRP.

Another third technique (not pictured here) showed benefit for SUI but described injecting 4 cc of PRP spread out in 0.1 ml aliquots for FORTY separate injection points.

Please Help

I have no study showing which of the three separate techniques described above gives the best result. There is no question about which causes the least amount of pain: (1) 40 separate injections vs. (2) five injections into the urethral wall requiring general anesthesia in the operating room vs. (3) the O-Shot® which can be done usually completely pain-free and only requires topical anesthesia and a pain-free lidocaine block in the office.

Though we still do not have a study documenting which works the best of these three techniques (or which of other techniques that you might imagine), hopefully, I have given you a quick version of why I think our method (which we have been doing for a decade with over 100,000 women treated) may be best.

More importantly, what I hope I’ve shown is that there is a need for us to think about carefully and study which might be the best technique because we think technique matters. One of the dangers of having taught and provided the O-Shot® procedure for 11 years is that I may start to believe everything I say...first you show something is feasible, then you have the herculean effort of looking at the infinite number of variables to find the best way.

Please help us study and think about this categorically new way to improve the health and function of the female genitourinary tract.

Summary

  • PRP improves tissue health by collagen production, neovascularization, neurogenesis, attenuation of the autoimmune response, anti-bacterial effects, improving glandular function, and muscle repair.
  • The strategic injection of PRP into areas of damaged tissue with the resultant improvement of health and function of tissue has been demonstrated in thousands of studies over the past two decades.
  • An increasing number of studies show that this principle of injection of PRP into the damaged or aging tissue of the urinary sphincter may help restore urinary continence in some women resistant to other therapies.
  • The injection technique matters since only tissue exposed to the PRP will primarily benefit.
  • Only those licensed by the Cellular Medicine Association (after testing) can legally advertise using the name “O-Shot®.” This is done so that a greater degree of predictability of safety and results can be offered to women who may choose PRP injections as a mode of treatment.
  • The O-Shot® procedure has and will continue to evolve as the research accumulates from the members of the Cellular Medicine Association and others.
  • The O-Shot® procedure is varied based on the functional anatomy and the pathophysiology of the disease process in any individual woman.
  • This report gives an overview of the principles behind the O-Shot® procedure and Emsella therapy but does not constitute training or license to do the procedures.
  • I hope if you are not yet a member of the Cellular Medicine Association (CMA) that you will consider joining our organization and studying our training materials, we need more help thinking about and researching these ideas:
  • If you are already a member of the CMA, I hope you will continue to support our mission by participating in our weekly journal club and sharing your observations with your patients and your thoughts about the current research.

My goal is to be a pipe for the movement of ideas. I continue to be grateful every day for the members of the CMA who have shared ideas that make this report possible. And, most of all, I am grateful for the women who have been patients who have trusted me to teach me; with old ideas and new, the best book is observing and listening to the one woman in front of you who will teach you about her disease and how to make her well—if you listen.

References

Selection of Papers Demonstrating Neurogenesis with PRP

Chung, Eric. “Regenerative Technology to Restore and Preserve Erectile Function in Men Following Prostate Cancer Treatment: Evidence for Penile Rehabilitation in the Context of Prostate Cancer Survivorship.” Therapeutic Advances in Urology 13 (January 1, 2021): 17562872211026420. https://doi.org/10.1177/17562872211026421.

Foy, Christian A., William F. Micheo, and Damien P. Kuffler. “Functional Recovery Following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma.” Plastic and Reconstructive Surgery. Global Open 9, no. 9 (September 2021): e3831. https://doi.org/10.1097/GOX.0000000000003831.

Kuffler, Damien P. “Platelet-Rich Plasma and the Elimination of Neuropathic Pain.” Molecular Neurobiology 48, no. 2 (October 2013): 315–32. https://doi.org/10.1007/s12035-013-8494-7.

Sánchez, Mikel, Eduardo Anitua, Diego Delgado, Peio Sanchez, Roberto Prado, Gorka Orive, and Sabino Padilla. “Platelet-Rich Plasma, a Source of Autologous Growth Factors and Biomimetic Scaffold for Peripheral Nerve Regeneration.” Expert Opinion on Biological Therapy 17, no. 2 (February 1, 2017): 197–212. https://doi.org/10.1080/14712598.2017.1259409.

Wu, Yi-No, Chun-Hou Liao, Kuo-Chiang Chen, and Han-Sun Chiang. “Dual Effect of Chitosan Activated Platelet Rich Plasma (CPRP) Improved Erectile Function after Cavernous Nerve Injury.” Journal of the Formosan Medical Association, March 27, 2021. https://doi.org/10.1016/j.jfma.2021.01.019.

Selection of Papers Demonstrating Muscle Revival from PRP

Bernuzzi, Gino, Federica Petraglia, Martina Francesca Pedrini, Massimo De Filippo, Francesco Pogliacomi, Michele Arcangelo Verdano, and Cosimo Costantino. “Use of Platelet-Rich Plasma in the Care of Sports Injuries: Our Experience with Ultrasound-Guided Injection.” Blood Transfusion 12, no. Suppl 1 (January 2014): s229–34. https://doi.org/10.2450/2013.0293-12.

Bubnov, Rostyslav, Viacheslav Yevseenko, and Igor Semeniv. “Ultrasound Guided Injections of Platelets Rich Plasma for Muscle Injury in Professional Athletes. Comparative Study.,” n.d., 5.

Le, Adrian D.K., Lawrence Enweze, Malcolm R. DeBaun, and Jason L. Dragoo. “Platelet-Rich Plasma.” Clinics in Sports Medicine 38, no. 1 (January 2019): 17–44. https://doi.org/10.1016/j.csm.2018.08.001.

Middleton, Kellie K, Victor Barro, Bart Muller, Satosha Terada, and Freddie H Fu. “Evaluation of the Effects of Platelet-Rich Plasma (PRP) Therapy Involved in the Healing of Sports-Related Soft Tissue Injuries.” The Iowa Orthopaedic Journal 32 (2012): 150–63. http://www.ncbi.nlm.nih.gov/pubmed/23576936.

Moraes, Vinícius Y, Mário Lenza, Marcel Jun Tamaoki, Flávio Faloppa, and João Carlos Belloti. “Platelet-Rich Therapies for Musculoskeletal Soft Tissue Injuries.” The Cochrane Database of Systematic Reviews 12 (January 2013): CD010071. https://doi.org/10.1002/14651858.CD010071.pub2.

Selection of Papers Showing Help from PRP Injections for Stress Urinary Incontinence

Athanasiou, Stavros, Christos Kalantzis, Dimitrios Zacharakis, Nikolaos Kathopoulis, Artemis Pontikaki, and Themistoklis Grigoriadis. “The Use of Platelet-Rich Plasma as a Novel Nonsurgical Treatment of the Female Stress Urinary Incontinence: A Prospective Pilot Study.” Female Pelvic Medicine & Reconstructive Surgery 27, no. 11 (November 2021): e668–72. https://doi.org/10.1097/SPV.0000000000001100.

Callewaert, Geertje, Marina Monteiro Carvalho Mori Da Cunha, Nikhil Sindhwani, Maurilio Sampaolesi, Maarten Albersen, and Jan Deprest. “Cell-Based Secondary Prevention of Childbirth-Induced Pelvic Floor Trauma.” Nature Reviews Urology 14, no. 6 (June 2017): 373–85. https://doi.org/10.1038/nrurol.2017.42.

Indian Journal of Medical Ethics. “Cosmetic Surgical Procedures on the Vulva and Vagina - an Overview.” Accessed January 18, 2022. https://ijme.in/articles/cosmetic-surgical-procedures-on-the-vulva-and-vagina-an-overview/.

Ford, Abigail A., Lynne Rogerson, June D. Cody, and Joseph Ogah. “Mid‐urethral Sling Operations for Stress Urinary Incontinence in Women.” Cochrane Database of Systematic Reviews, no. 7 (2015). https://doi.org/10.1002/14651858.CD006375.pub3.

Gorton, E, S Stanton, A Monga, A K Wiskind, G M Lentz, and D R Bland. “Periurethral Collagen Injection: A Long-Term Follow-up Study.” BJU International 84, no. 9 (December 1999): 966–71. http://www.ncbi.nlm.nih.gov/pubmed/10571621.

Joseph, Christine, Kosha Srivastava, Olive Ochuba, Sheila W. Ruo, Tasnim Alkayyali, Jasmine K. Sandhu, Ahsan Waqar, Ashish Jain, and Sujan Poudel. “Stress Urinary Incontinence Among Young Nulliparous Female Athletes.” Cureus 13, no. 9 (September 2021). https://doi.org/10.7759/cureus.17986.

Kirchin, Vivienne, Tobias Page, Phil E. Keegan, Kofi OM Atiemo, June D. Cody, Samuel McClinton, Patricia Aluko, and Cochrane Incontinence Group. “Urethral Injection Therapy for Urinary Incontinence in Women.” The Cochrane Database of Systematic Reviews 2017, no. 7 (July 2017). https://doi.org/10.1002/14651858.CD003881.pub4.

Lee, Patricia E., Rose C. Kung, and Harold P. Drutz. “PERIURETHRAL AUTOLOGOUS FAT INJECTION AS TREATMENT FOR FEMALE STRESS URINARY INCONTINENCE: A RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL.” Journal of Urology 165, no. 1 (January 2001): 153–58. https://doi.org/10.1097/00005392-200101000-00037.

Long, Cheng-Yu, Kun-Ling Lin, Chin-Ru Shen, Chin-Ru Ker, Yi-Yin Liu, Zi-Xi Loo, Hui-Hua Hsiao, and Yung-Chin Lee. “A Pilot Study: Effectiveness of Local Injection of Autologous Platelet-Rich Plasma in Treating Women with Stress Urinary Incontinence.” Scientific Reports 11, no. 1 (December 2021): 1584. https://doi.org/10.1038/s41598-020-80598-2.

Nikolopoulos, Kostis I., Vasilios Pergialiotis, Despina Perrea, and Stergios K. Doumouchtsis. “Restoration of the Pubourethral Ligament with Platelet Rich Plasma for the Treatment of Stress Urinary Incontinence.” Medical Hypotheses 90 (May 2016): 29–31. https://doi.org/10.1016/j.mehy.2016.02.019.

O’Connor, Eabhann, Aisling Nic an Riogh, Markos Karavitakis, Serenella Monagas, and Arjun Nambiar. “Diagnosis and Non-Surgical Management of Urinary Incontinence &ndash; A Literature Review with Recommendations for Practice.” International Journal of General Medicine 14 (August 16, 2021): 4555–65. https://doi.org/10.2147/IJGM.S289314.

Oshiro, Takuma, Ryu Kimura, Keiichiro Izumi, Asuka Ashikari, Seiichi Saito, and Minoru Miyazato. “Changes in Urethral Smooth Muscle and External Urethral Sphincter Function with Age in Rats.” Physiological Reports 8, no. 24 (2021): e14643. https://doi.org/10.14814/phy2.14643.

PANDIT, MEGHANA, JOHN O. L. DELANCEY, JAMES A. ASHTON-MILLER, JYOTHSNA IYENGAR, MILA BLAIVAS, and DANIELE PERUCCHINI. “Quantification of Intramuscular Nerves Within the Female Striated Urogenital Sphincter Muscle.” Obstetrics and Gynecology 95, no. 6 Pt 1 (June 2000): 797–800. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192577/.

Perucchini, Daniele, John O.L. DeLancey, James A. Ashton-Miller, Andrzej Galecki, and Gabriel N. Schaer. “Age Effects on Urethral Striated Muscle II. Anatomic Location of Muscle Loss.” American Journal of Obstetrics and Gynecology 186, no. 3 (March 2002): 356–60. https://doi.org/10.1067/mob.2002.121090.

Perucchini, Daniele, John OL DeLancey, James A. Ashton-Miller, Ursula Peschers, and Tripti Kataria. “Age Effects on Urethral Striated Muscle I. Changes in Number and Diameter of Striated Muscle Fibers in the Ventral Urethra.” American Journal of Obstetrics & Gynecology 186, no. 3 (March 1, 2002): 351–55. https://doi.org/10.1067/mob.2002.121089.

Wiśniewska-Ślepaczuk, Katarzyna, Agnieszka Pieczykolan, Joanna Grzesik-Gąsior, and Artur Wdowiak. “A Review of Aesthetic Gynecologic Procedures for Women.” Plastic Surgical Nursing 41, no. 4 (October 2021): 191–202. https://doi.org/10.1097/PSN.0000000000000400.

Zhou, Shukui, Kaile Zhang, Anthony Atala, Oula Khoury, Sean V Murphy, Weixin Zhao, and Qiang Fu. “Stem Cell Therapy for Treatment of Stress Urinary Incontinence: The Current Status and Challenges,” n.d. https://doi.org/10.1155/2016/7060975.

Zubieta, Maria, Rebecca L. Carr, Marcus J. Drake, and Kari Bø. “Influence of Voluntary Pelvic Floor Muscle Contraction and Pelvic Floor Muscle Training on Urethral Closure Pressures: A Systematic Literature Review.” International Urogynecology Journal 27, no. 5 (May 2016): 687–96. https://doi.org/10.1007/s00192-015-2856-9.

Lee, Ping-Jui, Yuan-Hong Jiang, and Hann-Chorng Kuo. “A Novel Management for Postprostatectomy Urinary Incontinence: Platelet-Rich Plasma Urethral Sphincter Injection.” Scientific Reports | 11 (123AD): 5371. https://doi.org/10.1038/s41598-021-84923-1.

Chiang, Ching-Hsiang, and Hann-Chorng Kuo. “The Efficacy and Mid-Term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence.” Frontiers in Pharmacology 13 (February 8, 2022): 847520. https://doi.org/10.3389/fphar.2022.847520.

Selection of Papers Demonstrating Improvement of SUI with Magnet (Emsella®)

Azparren, Javier, and Judson Brandeis. “HIFEM PROCEDURE ENHANCES QUALITY OF LIFE OF ELDERLY MEN WITH POST-PROSTATECTOMY INCONTINENCE,” n.d., 6.

Evans, Kimberly, and Julene B Samuels. “FEMALE URINARY INCONTINENCE AND SEXUAL FUNCTION AFTER THE HIFEM® PROCEDURE,” n.d., 2.

Gözlersüzer, Özlem, Bestami Yalvaç, and Basri Çakıroğlu. “Investigation of the Effectiveness of Magnetic Field Therapy in Women with Urinary Incontinence: Literature Review.” Urologia Journal, January 9, 2022, 03915603211069010. https://doi.org/10.1177/03915603211069010.

He, Qing, Kaiwen Xiao, Liao Peng, Junyu Lai, Hong Li, Deyi Luo, and Kunjie Wang. “An Effective Meta-Analysis of Magnetic Stimulation Therapy for Urinary Incontinence.” Scientific Reports 9 (June 24, 2019): 9077. https://doi.org/10.1038/s41598-019-45330-9.

Samuels, Julene B. “HIFEM TECHNOLOGY – THE NON-INVASIVE TREATMENT OF URINARY INCONTINENCE,” n.d., 7.

Samuels, Julene B., Andrea Pezzella, Joseph Berenholz, and Red Alinsod. “Safety and Efficacy of a Non‐Invasive High‐Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life.” Lasers in Surgery and Medicine 51, no. 9 (November 2019): 760–66. https://doi.org/10.1002/lsm.23106.

Silantyeva, Elena, Dragana Zarkovic, Evgeniia Astafeva, Ramina Soldatskaia, Mekan Orazov, Marina Belkovskaya, Mark Kurtser, and Academician of the Russian Academy of Sciences. “A Comparative Study on the Effects of High-Intensity Focused Electromagnetic Technology and Electrostimulation for the Treatment of Pelvic Floor Muscles and Urinary Incontinence in Parous Women: Analysis of Posttreatment Data.” Female Pelvic Medicine & Reconstructive Surgery 27, no. 4 (April 2021): 269–73. https://doi.org/10.1097/SPV.0000000000000807.

Another Selection of Papers Showing Neovacularization from PRP

Araujo-Gutierrez, Raquel, Jeffrey L. Van Eps, Jacob C. Scherba, Albert Thomas Anastasio, Fernando Cabrera, Cory J. Vatsaas, Keith Youker, and Joseph S. Fernandez Moure. “Platelet Rich Plasma Concentration Improves Biologic Mesh Incorporation and Decreases Multinucleated Giant Cells in a Dose Dependent Fashion.” Journal of Tissue Engineering and Regenerative Medicine 15, no. 11 (2021): 1037–46. https://doi.org/10.1002/term.3247.

Bindal, Priyadarshni, Nareshwaran Gnanasegaran, Umesh Bindal, Nazmul Haque, Thamil Selvee Ramasamy, Wen Lin Chai, and Noor Hayaty Abu Kasim. “Angiogenic Effect of Platelet-Rich Concentrates on Dental Pulp Stem Cells in Inflamed Microenvironment.” Clinical Oral Investigations 23, no. 10 (October 2019): 3821–31. https://doi.org/10.1007/s00784-019-02811-5.

Li, Yuan, Shan Mou, Peng Xiao, Guining Li, Jialun Li, Jing Tong, Jiecong Wang, Jie Yang, Jiaming Sun, and Zhenxing Wang. “Delayed Two Steps PRP Injection Strategy for the Improvement of Fat Graft Survival with Superior Angiogenesis.” Scientific Reports 10 (March 23, 2020): 5231. https://doi.org/10.1038/s41598-020-61891-6.

Nolan, Grant Switzer, Oliver John Smith, Susan Heavey, Gavin Jell, and Afshin Mosahebi. “Histological Analysis of Fat Grafting with Platelet‐rich Plasma for Diabetic Foot Ulcers—A Randomised Controlled Trial.” International Wound Journal 19, no. 2 (June 24, 2021): 389–98. https://doi.org/10.1111/iwj.13640.

Norooznezhad, Amir Hossein. “Decreased Pain in Patients Undergoing Pilonidal Sinus Surgery Treated with Platelet-Rich Plasma Therapy: The Role of Angiogenesis.” Advances in Skin & Wound Care 33, no. 1 (January 2020): 8. https://doi.org/10.1097/01.ASW.0000615376.97232.0a.

Saputro, Iswinarno Doso, Sitti Rizaliyana, and Dhitta Aliefia Noverta. “The Effect of Allogenic Freeze-Dried Platelet-Rich Plasma in Increasing the Number of Fibroblasts and Neovascularization in Wound Healing.” Annals of Medicine and Surgery 73 (January 3, 2022): 103217. https://doi.org/10.1016/j.amsu.2021.103217.

Sclafani, Anthony P., and Steven A. McCormick. “Induction of Dermal Collagenesis, Angiogenesis, and Adipogenesis in Human Skin by Injection of Platelet-Rich Fibrin Matrix.” Archives of Facial Plastic Surgery 14, no. 2 (April 2012): 132–36. https://doi.org/10.1001/archfacial.2011.784.

Zhang, X.-L., K.-Q. Shi, P.-T. Jia, L.-H. Jiang, Y.-H. Liu, X. Chen, Z.-Y. Zhou, Y.-X. Li, and L.-S. Wang. “Effects of Platelet-Rich Plasma on Angiogenesis and Osteogenesis-Associated Factors in Rabbits with Avascular Necrosis of the Femoral Head.” European Review for Medical and Pharmacological Sciences 22, no. 7 (April 2018): 2143–52. https://doi.org/10.26355/eurrev20180414748.

An Optional Technique for Injecting PRP for Incontinence

Chiang, Ching-Hsiang, and Hann-Chorng Kuo. “The Efficacy and Mid-Term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence.” Frontiers in Pharmacology 13 (February 8, 2022): 847520. https://doi.org/10.3389/fphar.2022.847520

The Effects of Mid-Urethral Sling Placement on the Tissue of the Female Prostate and Female Sexual Function

Gaudet, D., D.G. Clohosey, J.L. Hannan, S.W. Goldstein, N. Szell, B.R. Komisarek, M.A. Harvey, et al. “249 Midurethral Sling Placement Disrupts Periurethral Neurovascular and Glandular Structures near Anterior Vaginal Wall: Potential Role in Female Sexual Dysfunction.” The Journal of Sexual Medicine 15, no. 7 (July 2018): S221–22. https://doi.org/10.1016/j.jsxm.2018.04.214.

 

Juice up your O-Shot® Skills for Great Benefit for Your Patients and for You

I just created a very powerful step-by-step way to understand and do what our most successful providers have done. To learn how to both provide the O-Shot® in an excellent way and to connect with women who need the procedure, take the journey with our new course; if you do all 3 modules, you and your patients should benefit greatly (click to start the journey...private for only our active and licensed O-Shot® providers)<--

Includes all of the following:
*Marketing
*Consent forms
*How to treat some cases of stress urinary incontinence, urge incontinence, dyspareunia, anorgasmia, decreased libido, & lichen sclerosus
*Which problems are more likely to be helped and which are less likely to benefit.
*A list of supplies needed
*Multiple videos of the procedure
*A tool for surveying your patients in a private way
*How to make videos to explain your procedures to your patients.
*A way to download a year's worth of emails to send your patients
*Much, MUch, MUCH more

Prizes will come to those who complete all three modules<--

Physicians and nurse practitioners interested in learning the procedure and enrolling in the course can find more information about requirements here<--

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