Lasers + O-Shot® Equals Dry in Australia

I was looking through the most recent research about stress incontinence, and saw this really important paper that came out of Adelaide, Australia from some of our colleagues down that way. Stress incontinence is really a severe problem that people don't think about. They think about it more of as a hygiene problem. But when you have stress incontinence, it interferes with your life. You have trouble sleeping. It can make it difficult to exercise, so you have weight gain. You're up in the night, trying to urinate, so you're not as rested the next day. It interferes with your focus at work. So it can be a problem that really changes your life.

That's the definition of stress incontinence, if it's a hygiene problem or it interferes with your life. It's pretty common. Close to half of the women that are 50 and up, and it's 1 in 20 of women in their twenties, so it's a really common problem. It's worth looking at because all the things that have been tried are useful. Some women are able to help this with Kegels. The surgeries are still an important tool that should be used when necessary. The mid-urethral sling, 90% of people get good results with that, only 10% have problems or have it fail. But the problem is that, with the surgery, there is some risk to the nerves that are involved with sexual response. And of course diapers are a last resort.

So there's this new thing called the O-Shot®, where you use plasma, PRP, to inject it in the right place. These authors, they combine the use of our O-Shot® with a laser. So the lasers usually go about the thickness of a business card, not much thicker than that. So it's not a really deep laser, but it's enough to cause some changes and improvement in the structure and the health of the tissue, especially when you combine it with our O-Shot®.

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So let's look at what happened. I think this summarizes it the best. If you look at this picture, in the beginning, at baseline, the people who participated, 62% percent of them were frequently bothered by their incontinence, and 37% were bothered daily. But by the time they finished the study, it was more that shifted quite dramatically, so that you can see that many of them were not bothered at all or occasionally, and only 10% were daily, where it was more like 100% were either daily or frequently in the beginning.

The fun thing about this procedure is that, the procedure being both the laser and combination with the O-Shot®, is that the downside is minimal so that if it doesn't work, you can still go to surgery. But if it does work, and we're seeing over 90% effectiveness with either the O-Shot® alone or combined with the laser, and when it works, you see great results, with the side effect of sex getting better.

So I think it's worth discussing this research with your physician. If you want to find someone who's expert at the O-Shot®, check out our list of providers on our directory, those who are actually licensed to perform the procedure under the standards that we've come up with. So check out the research, read it, and share it with your doctor.

Here's where to read the research<---

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Research for Incontinence and for Better Sex

Here's new research about how to improve urinary continence in women...

Click here to read the research<--

So stress incontinence is a really serious problem that can affect your life and in ways that are sometimes difficult to deal with it, both in your personal and your business life. It can make it difficult to focus at work. It makes it difficult to get through a meeting, difficult to travel without stopping, it wakes you up at night, it makes it hard to exercise because you might be leaking urine and you're not sleeping well so it makes it hard to feel rested during the day so it's a significant problem and a lot of research going on trying to find an in between.

The pills that you take can sometimes cause anticholinergics can cause trouble with constipation, trouble thinking and associated with dementia and surgery is a viable option but all of us would like to avoid surgery if we can. So here's a really interesting study where they looked at successfully using autologous drive muscle STEM cells. Autologous muscle drives cells to grow, not STEM cells, but muscle drives cells to grow the bulk of the sphincter that helps a woman control her urine and actually it's not a circumferential sphincter like a man, it's more like a flap which makes it more difficult to hold urine and that flap is only a few cells thick so increasing the strength, just like you strengthen your bicep might help with that and that's exactly what they showed; significant increase in sphincter volume as in a larger bicep muscle instead of larger sphincter volume or muscle to hold the urine in when compared with the placebo group.

So check this out. It's not something that's mainstream yet as far as being able to offer but you might want to talk with an alternative which does something similar which is using PRP. In the athletic committees have sometimes even banned platelet rich plasma because not only does it heal tissue, but can add sometimes strength to the muscle.

So it's possible that one of the reasons our O-Shot is improving incontinence is because platelet rich plasma can increase the muscle strength as well as improve the health and the blood flow around the tissue. So a side effect could be improved sexuality response with orgasm or ability to have orgasm. So you might want to talk with your physician about this if they're not a provider, there's training on the website and we have a list of licensed providers on the website that are already trained, agreed to follow strict criteria and with the FDA approved devices.

It's not for everybody but that's who I would contact to find out more information about this or talk with your physician about becoming certified or licensed to do the procedure. Hope you find it helpful and you'll share this idea with your physician or with someone who might be suffering with incontinence.

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

Case Report

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

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

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

 

 

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

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

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

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

Edward Tangchitnob, MD, FACOG

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


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