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 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 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 complicated 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 its self) 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 midurethral 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 benefit. 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 benefit 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 a 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 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 a 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 upon diseases process. All licensed providers also agree to only use devices to prepare the PRP that have 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, preparing the PRP in the proper way, and injecting the PRP with the agreed-upon technique after using local anesthesia the 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 their demonstration of 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 carefully think about 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 the health of tissue 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 are showing that this principle of injection of PRP into the damaged or aging tissue of the urinary sphincter may be helpful in restoring urinary continence in some women resistant to other therapies.
  • 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 upon 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 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, to 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.

 

JCPM2022.03.08.InterstitialCystitis.SUI.RiversOfGold.FxAnatomy

Topics Discussed Include the Following...

*Wordtracker and how I use it (one of my top 5 marketing tools)
*PRF vs PRP
*An alternative, much more painful, way to treat stress urinary incontinence using PRP
*The functional anatomy as it relates to the O-Shot® procedure
*Interstitial Cystitis and the O-Shot® procedure
*The Common Thread that runs through all CMA strategies & The great Sculptor, Rodin
*Two of my favorite ways to use Wordtracker to find rivers of gold.

Video/Recording of CMA Journal Club, Pearl Exchange, & Marketing Tips

Transcript, Research, Relevant Links

Transcript

Top 5 Marketing Tool

Good evening and welcome to tonight's Journal Club with Pearls & Marketing. This is one of the most important tools I have used called Wordtracker. It's a paid version, I'll show you how it works for me and how it's helped my practice tremendously. And actually in the background, has been helpful in educating our patients about everything that we do and I'll show you a cheap version of it, that's actually free, that's on Google.

Before we get to that, I want to jump to the articles that I found this past week that I think you will find very helpful. Remember for every article that we talk about, that's a potential message to your patients because they don't know what you know. And so if you let them know about it, then either they or someone they know might benefit from it. So let's pull up what I've found most helpful.

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Usually, I go through several 100 items to find what I think is most useful, that's something esoteric that may be interesting as far as general education, but I try to find the things that can change the way you take care of your patients the very next day, and of course, be rewarded with it with more profitability to take care of your family. And I'll put the links to all these. These we skipped last time because we happened to fall on the same time the president was giving his State of the Union Address and so we skipped that. But apparently Tuesday night at 9:00 PM Eastern Time is a good time because I'm sure they thought about that a lot when they tried to figure out when the president should talk. So we'll keep this time.

And let's start by, I want to give you this link, even though we talked about this in our last meeting. This is such a useful... I want to bring it up again. I'm not going to go over it again because we've already discussed it. But in case you missed the last time, I just put a link to this in the chatbox. I like it because it reviewed so many things, from micro-needling, for acne, for hair loss, talked about all these different ways to use platelet-rich plasma. And I think with a reference list that's very helpful. So that's a good one to keep in mind. This classification, and again, something that's useful if you're going to be doing research, and I'll throw this one in the chatbox as well because many of you are doing research and as you read the research, one of the things that we get criticized about, those of us who do cellular therapies, is that there's not a good apples to apples way to talk about it. And looking over this gives you ways to think about that.

PRF vs PRP

So let's get to this week's articles. So here's an article where they use platelet-rich fibrin or PRF, which I haven't talked about much. I think it's useful to note that one of the authors is paid by one of the manufacturers of the kits for this, but still, I haven't talked about PRF much. And they talk about here, drawing 40 cc's of blood, getting the platelet clot, and then using a blade between a luer lock connector, passing the clot back and forth to micronize it. And that gets it small enough to pass through a 20-gauge needle. So there are several things that I don't like about it. The good thing I like is, grew some hair back. Of course, we're able to do it through a 30-gauge needle with PRP and you don't have to draw as much blood, you can do our hair treatments and most of what's in the literature withdrawing 10 cc's of blood and using the five cc's of one and a half to two times concentration that comes from a simple gel kit.

So it's nice to know that PRF works. It's also interesting to note that in this case report, it seems to me that there's a lot more trouble to be had and more pain to be had since you need a larger gauge needle, even after do you micronize the clot by passing it back and forth. So even if you're not doing PRF, it might be useful to look at this, I'll put the link in the chatbox. And all these links go away after the webinar is over so it's useful, even if you don't read them now, just click on them so they're open and you have it when the webinar is done.

I know some of your colleagues will talk about PRF and they get good results, I'm not knocking it. I'm just offering this as a reason why I don't use it in my practice.

An alternative, much more painful way, to treat SUI with PRP

This article is also instructional, you can see they actually helped us out because they inject it around the urethra with PRP for female stress incontinence. And I'll come back to the details, but I want to go ahead and give you the conclusion. It demonstrated the efficacy and safety of repeated urethral sphincter injections of PRP. And by the way, they went once a month for four injections. And they showed that they had a high success rate and it lasted up to 12 months after the treatment with no serious sequelae. Here's where I wish these guys would've given us a call before they did the study because the way they did it was so painful the people had to be put under general anesthesia. In my opinion, they took what was a pretty simple way to do our O-Shot® and complicated it.

Grateful they did it and grateful they showed benefit, but they complicated it and they made it a lot more painful.

Functional Anatomy as it relates to the O-Shot® procedure

So let me show you a picture of what they did. First, they put a sterile Q-tip in the urethra to see the orientation (ready to sign up yet?).

Then they injected at five separate injection points around the urethra. You realize that's the external meatus so they're within hearts line. So this is extremely, extremely painful if done on an awake patient. Guys, as you know, this is innervated in the same way that the urethra within your penis. So this would be like taking a needle or a fishhook and going through the meatus and injecting the urethra as it passes through the penis five times. Obviously not something you want to do on an awake patient, but I think the idea behind what they're trying to do of course is to duplicate what we've been talking about now for a decade. And the idea behind it is good.

I'll show you some anatomy so you'll know more about what I'm visualizing when I make that statement. But I wish they would've given us a call so they wouldn't have tormented these poor ladies.

Let me show you a picture and I'll come back to the next study. Let's see. Here. So this is a sketch that I made from DeLancey's chapter in the Urogynecology Textbook and it came from research he did on functional anatomy about the urogenital sphincter in a female. There's this striated muscle portion and there's a smooth muscle portion. So you can see the striated muscle portion at level one up here near the uretero-vesicular junction goes just around the urethra.

Then at the mid urethra, it goes around the urethra and around the vagina, this is the collapsed vagina. This is the urethra.

And by the time you get to the distal urethra, the striated sphincter goes completely around the vagina and urethra.

But there's also a smooth muscle component that is not illustrated here that surrounds the urethra.

And then of course the urethra wall itself has a plexus of arteries and veins with venules. So there are venules that can collect blood or collapse so it's tumescent just like in the penis and that tumescent also contributes to the closing pressure, the resting closure pressure to the incontinence mechanism.

So one way to make this painful would be just to inject five times around the urethra. If you have injected the face though, you know how that PRP, not PRF, but PRP is so aqueous it just hydrodissects throughout the tissue, wherever it is.

So when we inject the body of the clitoris, we actually have some ultrasound studies showing that our presumption was right. We have some visualization by one of the radiologists in our group, Dave Harshfield, who showed actual physical injection just in the body, this truly acts like a wick and the PRP takes, as all water does, takes the path of least resistance. And that would be staying within the tissue of the Corpus Cavernosum.

In the same way, injecting around the urethra, this is from the study I just showed you, so injecting in these separate points like this, it would take the path of least resistance which would be down the wall of the urethra.

But even one cc, five cc's into this is a humongous amount of fluid. The next time you do a Vampire Facelift®, put one cc of fluid in the cheek and watch, it covers the entire anterior portion of the cheek, just one cc. So five cc's balloon this thing up like crazy, would've hurt beyond belief had it been done on an awake patient. And was more than necessary, just one side of this would've been enough to uncover the entire urethra. Think about the volume. What's the volume, what's the size of a cylinder that's five cc's? It's much larger than this urethra wall.

And if you think about the volume, so where we do our injection here with the O-Shot®, by just coming around hearts line, that simple move and coming around hearts line and coming just the other side of the Hymenal Ring. Now you're in an area where it's innovated almost no pain, and you can slide that needle into that space. And if you calculate the volume of the space, well here it's basically nothing because the tissue is up against each other, the urethral wall and the vaginal wall are touching. And here you still have a very small space so that even four cc's is enough to hydrodissect this whole area.

Now what I just told you, I could be wrong about all of it, and I could be proven to be wrong but if you go back to the study we're looking at, and at the results they had, it's actually less than what we normally see with our O-Shot®, but, it was significant enough that they helped our cause by demonstrating that even with a procedure that's more painful than what we do, that there's still benefit.

But if you look at the results, they did 26 women, the study two years, and they showed that benefit, but it was a lesser percentage than what we see with our O-Shot® procedure.

Interstitial Cystitis Research

Okay. Next one. And by the way, jump in anytime we've got a good turnout tonight and so just punch the little button and I'll unmute your mic if you have something to contribute, because I definitely want to hear it. This one is just, is one of many. It surprised me, I just recently reviewed the literature that's coming out about interstitial cystitis and I'll put the link to this while I'm thinking about it. Because, anecdotally I keep hearing no one's done the study yet and we have two we're paying for right now and so that's all our budget allows, but we spend unfortunately much more on lawyering than we do on protecting our name and running off people who pretend to be us than we do on research. But we do what we have to do, we don't want people using our name to trick people into doing things that are not good for them.

So there's the DOI number for this study and I'll just... Also, it's an editorial about another study, but I thought the author of this editorial summed things up very succinctly and very convincingly. So I'm just going to quickly read this. Platelets play a fundamental role... By the way, if you go through the research, all the research is reporting intravesicular injections of the platelet-rich plasma. And one of our providers actually does that, he's an anesthesiologist and he does it that way and he gets great results. But then we have at least 10 urologists slash gynecologists, some of each, that have told me they're getting great results, just doing with our usual O-Shot® procedure.

So I don't know if that means they're inadvertently injecting the bladder, which is right there of course. And you get a little cystic seal, it could be pretty simple to inject the bladder right there. Or, if there's something about what I'm about to read to you that makes our regular O-Shot® work. So just bear with me and you'll understand the reasoning why this should work. And then I want to get to some marketing stuff that could change the way you think about your marketing that saves you money and makes it more effective.

Okay. Platelets play a fundamental role in tissue regeneration, actively participating in the process of mitosis, chemotaxis, listen, this is the list that should give you an erection if you're a man. Process of mitosis, chemotaxis, all this from platelets, differentiation and growth of pluripotent mesenchymal cells. So that pluripotent cell is really what it's all about. That's of course what causes wound healing when you have surgery. And that's really the main thing we're doing with our platelets. And it's really what people are doing when they do stem cells to my understanding because the stem cells die and in the end, it's the chemotaxis factors and all the other things that happen that actually bring the pluripotent cells to the area or activate those that may lie there locally, like in muscle.

In addition to inducing extracellular matrix production to hold it all in place. The proteins are contained... Okay, then I'll skip all these because you guys already know what's in the platelets, that'll bore you. But this part is really profound. Recent evidence confirms the great potential of using, look at this list, confirms the potential of using PRP in Plastic, Vascular Surgery, Orthopedics Trauma, Ophthalmology, Dermatology, Gynecology, Sports Medicine, and Female Urology. PRP was previously proposed as a polypropylene mesh coating.

If we assume that one of the most relevant pathophysiological mechanisms of interstitial cystitis is the increase in urothelial permeability related to proteoglycan deficiency, the use of PRP has a consistent rationale and may be clinically useful mainly if other researchers are able to reproduce these results. And they have, they've reproduced it, and reproduced it, and reproduced it.

The Common Thread that runs through all CMA strategies & The great Sculptor, Rodin

So it's not voodoo, it has a clinical strategy based on the hardcore cell biology, which is what we're about. That's really the thread that we're into. I was thinking today that there are lots of houses going up, people are moving to Alabama, like crazy. Nobody wears a mask here and we have hardly any, we just don't have much crime here. So people are discovering that and we have a nice climate and low taxes. So maybe I shouldn't say that, more people know about it, but watching construction and these artisans are in high demand, the brick layers, the plumbers, we'll just stick with the brick layers. But if you had brick that was fragile, it was fryable it wasn't good brick, it broke apart. You could be the best brick layer in the world and you're still not going to make a very useful house.

So the surgeons, you guys are the surgeons, you can be an artist, you can be Rodin, the great French sculptor, but if you don't have good marble and you're trying to sculpt with sand, you can't do it. And so really, the common thread that runs through everything we're about with our CMA is that if you think about the actual bricks or the marble that you're sculpting with, which of course is the tissue. And if you think about that the healthy cells make that tissue stronger and more functional. If there's a secretive function like with the vagina and the dryness with someone who's had breast cancer, that study you guys know that was published on menopause, you can cut and sew, which is needed, and you need to be a good artisan and a good craftsman to create with that tissue the thing that's more functional.

But at the cellular level, that's what's making the thing you're sculpting with and that's what we're about. And that's what this article is about, that people are finally coming around that PRP helps that cellular level. And you don't have the drama that goes with something like stem cells that needs RVs and puts the microscope of the FDA on your rear end. So, anyway, so I loved this one mostly because of the editorial, but I did want to remind you guys that there are a number of studies, I counted about 12 a couple of days ago when I looked at this, showing that PRP helps with interstitial cystitis.

Popular Trends on Google, how they relate to your practice, and what word to not use

Now last one, and this one I'm getting to, I'm swapping over to marketing. I don't see any hands up so I'll keep going here. This marketing part, the Publication Frequency and Google Trends Analysis of Popular Alternative Treatments. Okay, now we're on the marketing.

First of all, strike this word from your vocabulary. And I can usually spot people that are jealous or angry. You realize, you know, my dad told me this is a child. See, this just came out. My dad told me this when I was a child because in the first grade I wanted to be a doctor. And he said, "Son, just be ready. People will always want..." Listen to this because it's always been this way, it will always be this way. "People will always want their lawyer to be rich and they'll always want their doctor to be poor."

If you read the novels of Dickens, you can tell he was a lover of the art of healing and of physicians. But the physicians of that day either had so much money, medicine was a hobby, or they took a vow of poverty. That's really how people want to see it, they want to think that you're not profiting from their pain. And maybe that's how it should be, maybe it should go back to that and certainly seems to be going back that way.

But what's surprising is this, your colleagues think the same way. This is from the Yale School of Medicine and between the lines here, what they're saying is we think doctors should be poor and it looks like some people are making money and we don't like that.

So if you do become profitable as a physician, my suggestion is that you hide the car that you're proud of and you hide your house because when you talk about your money, little birds talk about it and your money flies away as a physician. If you're a lawyer, yep, you should flaunt it because people will trust you more, you should be as rich, wear the biggest ring you can, drive the fanciest car with the loudest muffler.

Okay. Anyway. So, but the reason I'm rambling about that, it's really what this article is about, is that doctors are making money, using words we don't use at the Yale School of Medicine. But this one I don't like, money or no money, I do not like the word alternative because of the implication and most of us don't use that word. But if it is on your website or you do use it, I want you to contemplate what it means.

Words are the dressings, it's the dress or the suit and tie of our ideas. So the idea is there, you can dress it up however you want, but you put the wrong clothes on it and it gets misinterpreted. Now, I know you don't think this way but if you wear a suit that looks like you're a, I don't know, a prisoner, people may think you're a prisoner. That's a bad example. Anyway, people judge you by the way you dress, they will judge your ideas by how you dress them.

Here's the implication of the word "alternative"...It means that something instead of, and so if you use that word, it's implying that you're doing something and you are denying that the thing at the drug store works or that surgery works. And you want something instead of the things that insurance pays for. Yeah, I'm glad if I can do something that saves someone from a trip to the pharmacy, and I'm glad that I can do something that saves someone from even the excellent skills of a surgeon. On the other hand, when I had COVID 19, and after the fifth day, I was all about those monoclonal antibodies that came from a pharmacy. And I was all about alternating Advil and Tylenol when my fever was 105. And I did not look for something alternative growing out in the grass or in the woods behind my house.

So on the other hand, I also got in my sauna bath, which I had to buy from Canada because it's illegal to sell that in the United States because it goes to 220 degrees Fahrenheit. And I like to run it around 200 to 210 with is illegal to sell one that gets that hot, and you realize that's the boiling point. But I know that alpha interferon works better if I give myself a fever so, in the sauna, my body doesn't have to work to make a fever. And that, to me, that is not an alternative therapy, it's just using basic science about how fever and alpha-interferon and white blood cells demarginate when you have a fever and by giving myself a fever externally, my body doesn't have to go through the work of shivering to create one. So, that is not alternative; I call that adjunctive therapy.

All right. So right off the bat, I know where this guy's going, we should all be broke. But there's still more usefulness in this because what they have found is that people are searching for stem cell therapy, tumor therapy, CBD therapy, and PRP therapy and the number of people searching is going up dramatically.

So that's a good thing for us because that's what we do. Now, that brings me around to the tool that I wanted to show you and I think that's it for the research. I'll show you this insurance tool and then we'll shut it down for the night. A research tool that I like.

More about Wordtracker

Most people don't know this tool but it's extremely useful and it will save you money. Okay, hold on a second let me find it. Yes. Okay. And then I'll show you a way to do something similar for free. So this is Wordtracker, now, and it costs a little bit per month, but look, if you look for PRP I just put PRP for joints, because that's what that article I just referenced about. Oh, I didn't give you the link to it, let me go grab that real quick. The article about the publication frequency for what they called alternative treatments for arthritis. I'm getting distracted now, I'll put it in the email that goes out.

So what Wordtracker does is you put this in and I can look and see how many times people have searched it for all these different things. I like to put Google in there, or I could put YouTube in there. So I put PRP for joints and I got this. So in the past 30 days, that's what this means, you can hover there. Average number of searches per month.

So in the past 30 days, over the past year, people, so over the course of a month, people have put this exact phrase PRP injection of the knee, into the search bar of Google 2,400 times in a month, or about 800 times a day, right? So it's pretty good. But now it gets much better than that. If you look here, it gives you the competition and this is the number I like.

These are the number of web pages that Google knows about where that phrase appears in both the title tag and the text of a backlink. So another web page has this phrase. So how many websites have this phrase on them and another link and a link on another page has this phrase on it?

That sounds more complicated so I think you know what I'm saying, but I'm going to draw it anyway. So if this is your website or webpage, and it has this phrase on the title, all right, then another page, which can be on your own website, doesn't have to be another person's website, but another page has this same for raise on it and when you click on it, it takes you to this page.

So out of the whole internet, Google only knows one page that has that, and there are that many searches per month. So that's a pretty good freaking opportunity. But check this out it gets better, wait a minute. Let me erase that thing.

These, so here's one, plasma injection for the knee is searched 6,666 times a month, or just call it, what's that? 10, 60, about 20 times a day, 22 times a day, give or take. And there is no website and there's no competition. So you used to, you could find things in the early days of the internet where this might be a million and no webpage. So you could make a webpage that sold almost anything and you're getting all the traffic. So a lot of early internet millionaires became that way because they found rivers of gold that no one was tapped into. Now it's harder to find these, but you can create a river, right?

So you can create a river by making up your own name, like O-Shot®. And so we'll see how it pops up and how... So my point I was just making, if you're injecting joints and you do that, you grab one of those things that aren't... Let me go back because I didn't finish my thought, I'm giving you the keys to the kingdom here, PRP injection joints. And by the way, I spent about two weeks doing this before I came up with the name Vampire Facelift® because I was looking where's the traffic and where's traffic going that no one's tapping into? So, I must have put a different, I did put a different phrase, let me take that one out.

How to find a river of gold with Wordtracker

Yeah, there we go. So if you find one of these that has a high volume with no competition, now what do you do? You go build a webpage. You realize I could talk about injecting the knee and use any one of these. I could use plasma injection of the knee, PRP in the knee, PRP injection knee, but I pick one or two or three that no one has been using and I make that the title, I use it in some of my descriptions and then I make another web, another mention of it on another page or two or three pages on my own website and I go on Instagram or Facebook or Twitter or whatever you're doing and you put a link with the same exact phrase back to the page where you talked about it, using that exact phrase. And now you have very shortly Google finds that and you have 20 searches a day where you're the only person catching that traffic.

And then you do that same thing for some of these others, that's what is called the long tail. So maybe you can't get the 2,400, but if you get 20 of these with lower traffic and you rule those well, you can wind up with more traffic than actually if you grab the more popular one, but you need to know the culture code, what words are people using? We all have a vocabulary and different cultures have different vocabularies. This is the vocabulary of people who's joints hurt. And you can experiment with different ones, right? All right, so that's... And I'm just showing you one of the ways to use this tool, a very strong tool.

Here's another way to use it and this is what I do before I build, I heard a lot of talk about this much because it's so freaking powerful. It's one of those secrets where I figure you have to earn the right to know how to use it and most doctors are just, they're not there yet. But I figure if you're here tonight, you're there.

So here's another quick, easy way. And that's Wordtracker. Here's a way to do it that's free. So I could also put PRP, it's inferior but it still works. And it's still more than most doctors will do. So I put PRP and look, it's already telling you what's popular. PRP training, PRP injection. I'm going to put PRP knee or yeah, I'll put PRP knee right here, knee injection. See it threw the injection in. Now what I do is I scroll down and at the bottom of the page, boom, related searches.

So it's telling me for free what's close to what other people are putting in there that's very popular. And I could grab some of these and do, and then take them to word tracker and look, because this is blind. It's telling me it's popular for all I know there are 500 more websites with this exact phrase and no websites with this exact phrase, which may be getting more searches. So they're just telling you related searches but you don't know as much. It's still a free, quick way to see what people are saying.

And I think that relates back to the paper I just showed you about where they looked to see what people were saying over the past year. And hopefully, you'll use some of this and the next time you talk on Twitter or make a video, you'll say, Hmm, and whatever it is you're talking about. And the same thing goes for what we do.

Let me show you one last tip and then we'll call it a night unless you guys have questions. Go back to Wordtracker and show you. If you do use Wordtracker and you're going to do, let's say you're doing our O-Shot®. Let's put in the P-Shot®, we already did O-Shot®, the P-Shot® now.
P-Shot®. So in the past year, there was an average of 6,700 searches per month for the word P-Shot®. And there are 191 websites with this in the title tag and another page with a link back to that same page with that exact phrase.

So this says P-Shot® and there's a hyperlink and you click on it and you go to the page that has P-Shot® as a title tag. There are 6,725 searches for that exact phrase, your competition's 191 pages. But, if I'm going to do a P-Shot®, maybe I grab one of these, here are 700 P-Shot® reviews. And then you review, you could obviously take that phrase and talk about just your P-Shot®, P-Shot® reviews and then it's here, I'm going to tell you about some of the results I've seen, the wins and the losses and review my own results. And then you can link another page and then you're going to catch all that traffic. At least you'll be at the top when people search for it.

And you can see as you go down, people who just use the PRP thing without the name, they're literally a hundred times less traffic than if they're using the P-Shot® name, actually more like 300 times more by the time you add all this up. So our name really is bringing us traffic and this doesn't count if I just put P Shot or P-Shot® with a dash. So if I do that, you'll see there's whole different stuff that comes up.

So this is how I don't guess, I know what I'm doing. And it helps me know if I'm paying price per click, it helps me know. So right now a P-Shot® near me that's $42.40 cents is the average price per click if I'm doing a Google click ad. But if I put PRP penis injections, that's very cheap. So if you're on our directory and someone clicks, then according to them, that one click is worth at least $42 which is one reason why to be on the directory, it's not the main reason, but it's one of them.

Okay, so hopefully I've given you some ideas and I think that hopefully you also got some ideas about things that you can actually do to take care of your people. You got some ideas about words not to use, alternative therapy, a new tool you can use and you now have a research project about the O-Shot®, a research paper about the O-Shot®, but done in this weird, painful way that you could shoot out to your patients and say, Hey, these people had to do general anesthesia, but they showed it worked. I've got a way to do it in the office without pain, give me a call, something like that.

So always flip, and because that paper just came out this month. So you can always use the news to talk about to make news. News comes out, you give that to your patients, here's some news. They're interested, they're smart people and here's what I think about this that just came out. Okay, I think with that, let me see if there are any questions, if not we'll call tonight. If I reviewed, I don't know. Let me look at that out and I'll see Angela. I remember seeing a Turkish paper OBGYN, let me see if, actually I could just throw it in the search bar and see, let's see what we get. Angela pointed out a paper that she thinks might be helpful.

Testicular Injection for Increased Sperm Count

Oh, I forgot to tell you there was also a paper that just came out. It was an animal study though, showing increasing... I'll have to look for it and let you know, I don't want to fiddle too much. Maybe that's it. I don't want to fiddle too much, I'll look for it and we'll talk about it next time. But there was a paper that just came out where they injected the testicles of animals that had been radiated and showed an increased sperm count. So I get asked that question a lot. I've injected my own testicles just to see what it was like and if you do it the right way there's hardly any pain and just sort of a little ache to it. I did it with a 27 needle. I didn't check sperm counts, but believe me, that study's coming. Somebody's going to do it, it just makes sense. But it finally came out in animals at least.

Matthew said easy PRP, easy spin system for the P-Shot®. They're not on my list of the ones that have the FDA device endorsement and so I've not used it. And so I don't want to say good or bad. I just know they've been less supportive of our group and they have less, the FDA doesn't approve blood, but they approve devices as you know, and it's not one of the devices that have been sanctioned to the degree that I would like, but I'm not going to condemn it, don't know it, haven't used it, it's a good question. So let us know if they get approval and I'll start throwing it out as one of the options. And I think with that, we'll call tonight. I hope you found something useful to take away at least don't use the word alternative. Trial Wordtracker before you build your next webpage or at least the free Google version. And I think with that, we'll call it a night. Thank you for coming out tonight.

Relevant Research

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.
Demyashkin, G. A., T. G. Borovaya, Yu Yu Andreeva, A. A. Nedorubov, Yu Yu Stepanova, M. A. Vadyukhin, V. I. Shchekin, S. N. Koryakin, P. V. Shegay, and A. D. Kaprin. “An Experimental Approach to Comprehend the Influence of Platelet Rich Growth Factors on Spermatogenesis.International Journal of Radiation Biology, March 8, 2022, 1–39. https://doi.org/10.1080/09553002.2022.2047820.
Pathak, Neil, Zachary J. Radford, Joseph B. Kahan, Jonathan N. Grauer, and Lee E. Rubin. “Publication Frequency and Google Trends Analysis of Popular Alternative Treatments to Arthritis.Arthroplasty Today 14 (February 28, 2022): 76–80. https://doi.org/10.1016/j.artd.2021.12.009.
Vazquez, Oscar Adrian, Rachel H. Safeek, Jacob Komberg, and Hilton Becker. “Alopecia Areata Treated with Advanced Platelet-Rich Fibrin Using Micronization.Plastic and Reconstructive Surgery Global Open 10, no. 1 (January 18, 2022): e4032. https://doi.org/10.1097/GOX.0000000000004032.

Relevant Links

-->Next class to learn to inject the major joints (knees, elbows, shoulders, Achilles) with PRP<--
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--> IMPORTANT (ONLY) IF YOU ARE NEW TO THE CMA: Please take any relevant online tests so that we can immediately list you (and your clinic) on the directories and start supplying you with other helpful marketing and educational materials. Testing takes an hour at most (including watching the videos. If you want to expedite the testing, you can simply call the CMA headquarters (1-888-920-5311 9-5 New York time Mon-Thur; 9-12 Fri) and one of our business consultants will log you in and walk you through where to find the study materials and the tests. If you are already on the directories for the procedure(s) you provide, then you already took the tests or did hand-on training with evaluation by your instructor.

O-Shot® CBD Arousal Oil. O-Shot® providers order wholesale by logging into the O-Shot® membership site, or by calling CMA Headquarters.

Altar™--A Vampire Skin Therapy™. All CMA members can order wholesale by logging into the membership sites and going to Dashboard-->Supplies

 

 

 

 

 

 

 

 

 

 

Charles Runels, MD

 

 

 

 

 

Cellular Medicine Association
1-888-920-5311