{"id":4344,"date":"2022-05-13T16:46:59","date_gmt":"2022-05-13T16:46:59","guid":{"rendered":"https:\/\/vampirefacelift.com\/members\/urinary-incontinence-in-women-a-new-way-to-avoid-surgerywhy-how-it-works\/"},"modified":"2022-05-13T16:50:28","modified_gmt":"2022-05-13T16:50:28","slug":"urinary-incontinence-in-women-a-new-way-to-avoid-surgerywhy-how-it-works","status":"publish","type":"post","link":"https:\/\/vampirefacelift.com\/members\/urinary-incontinence-in-women-a-new-way-to-avoid-surgerywhy-how-it-works\/","title":{"rendered":"Urinary Incontinence in Women: A New Way to Avoid Surgery\u2014Why & How it Works"},"content":{"rendered":"\r\n\r\n\r\n

The Overlying Most Important Principle in This Report<\/span><\/h3>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

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\u2014leading to inappropriate use and less than expected results.<\/p>\r\n\r\n\r\n\r\n

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 \u201cdoesn\u2019t work\u201d when we use the new therapy for a problem for which it would not be likely to help.<\/p>\r\n\r\n\r\n\r\n

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<\/em> 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).<\/strong><\/p>\r\n\r\n\r\n\r\n

Striated Urogenital Sphincter Grows Weaker<\/span><\/h3>\r\n\r\n\r\n\r\n

In considering where improved tissue health might improve stress urinary incontinence in women, first consider the striated component of the urogenital sphincter\u2014it accounts for one-third of the resting urethral closing pressure Delancey2017<\/a><\/p>\r\n\r\n\r\n\r\n

Here's my sketch of the striated muscle component\u2014taken from diagrams published by Delancey and others:<\/p>\r\n\r\n\r\n\r\n

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\"Striated\r\n
Striated Urogenital Sphincter<\/figcaption>\r\n<\/figure>\r\n<\/div>\r\n\r\n\r\n\r\n

The striated urogenital sphincter completely encompasses the urethra at level one; while, at level three, it encompasses both the urethra and the vagina.<\/p>\r\n\r\n\r\n\r\n

Beneath the striated urogenital sphincter lies smooth muscle that runs longitudinally which also contributes to the closing pressure.<\/p>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

To complicated matters even more, the function of the urogenital sphincter is known to be damaged by childbirth.<\/p>\r\n\r\n\r\n\r\n

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).<\/p>\r\n\r\n\r\n\r\n

Treatment Strategies Based on the Functional Anatomy of the Sphincter<\/em><\/span><\/h3>\r\n\r\n\r\n\r\n

Activation of the striated muscle of the sphincter independently of the patient\u2019s volition or the innervation of the muscle (for example with an Emsella\u00ae magnet)<\/em> 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.<\/p>\r\n\r\n\r\n\r\n

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\"\"<\/figure>\r\n<\/div>\r\n\r\n\r\n\r\n

Also, the sports-medicine literature offers robust support for the idea of using PRP to restore damaged or atrophic muscle<\/em>. And, multiple papers demonstrate neurogenesis propagated by the injection of PRP.<\/p>\r\n\r\n\r\n\r\n

If we propagated neurogenesis and muscle fiber restoration with PRP<\/em>, then that might be synergistic with Kegels or with magnet therapy or with surgery (if needed).<\/p>\r\n\r\n\r\n\r\n

The Urethral Wall<\/em> Acts Like a Penis<\/span><\/h3>\r\n\r\n\r\n\r\n

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).<\/p>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

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\u2014resulting in a decrease or resolution of urinary incontinence.<\/p>\r\n\r\n\r\n\r\n

Longitudinal Smooth Muscle of the Urethra<\/span><\/h3>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

Urge Incontinence<\/span><\/h3>\r\n\r\n\r\n\r\n

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\u2014if the PRP should be deposited in the proper place.<\/p>\r\n\r\n\r\n\r\n

PRP Injection Strategies for the Treatment of Urinary Incontinence<\/span><\/h3>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

In these published papers showing benefit for stress urinary incontinence with the injection of PRP, multiple techniques have been used; so, let\u2019s think about some of those techniques while keeping the functional anatomy in mind\u2014looking for a best possible strategy (at least with our present knowledge).<\/p>\r\n\r\n\r\n\r\n

The O-Shot\u00ae Procedure for Urinary Incontinence<\/span><\/h3>\r\n\r\n\r\n\r\n

With our O-Shot\u00ae procedure, we usually do two injections, one of which goes into the vaginal wall, hydro-dissecting the entire area.<\/strong><\/p>\r\n\r\n\r\n\r\n

Four CCs is enough to fill the whole space between the urethra and the vaginal wall and include the urethral wall\u2014if you put the needle where it to needs to go.<\/p>\r\n\r\n\r\n\r\n

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\"\"<\/figure>\r\n<\/div>\r\n\r\n\r\n\r\n

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\u2019ve described.<\/p>\r\n\r\n\r\n\r\n

The following is a snapshot from one of our instructional videos showing one of the two injections the way we teach the O-Shot\u00ae 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.<\/p>\r\n\r\n\r\n\r\n

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\"\"<\/figure>\r\n<\/div>\r\n\r\n\r\n\r\n

This method, when done properly, is called the O-Shot\u00ae procedure. The procedure can be done in the office using the person\u2019s own blood and without pain in most cases.<\/p>\r\n\r\n\r\n\r\n

I trademarked the term \u201cO-Shot\u201d 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\u00ae 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 \u201cO-Shot\u00ae\u201d in advertising if they fail to follow our standards.<\/p>\r\n\r\n\r\n\r\n

Physicians can apply to receive more detailed instructions and to be licensed to perform the O-Shot\u00ae procedure here\u2014>: OShot.com\/physicians<\/a><\u2014<\/p>\r\n\r\n\r\n\r\n

Example of Another Technique for Curing Urinary Incontinence with PRP<\/span><\/h3>\r\n\r\n\r\n\r\n

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\u2014in women with objectively-demonstrated severe incontinence.<\/p>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

The following photograph illustrates the injection points:<\/p>\r\n\r\n\r\n\r\n

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\"\"<\/figure>\r\n<\/div>\r\n\r\n\r\n\r\n

This is NOT the O-Shot\u00ae procedure; the O-Shot\u00ae 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.<\/p>\r\n\r\n\r\n\r\n

But, though these investigators did something other than an O-Shot\u00ae 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.<\/p>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

Please Help<\/span><\/h3>\r\n\r\n\r\n\r\n

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\u00ae which can be done usually completely pain free and only requires topical anesthesia and a pain-free lidocaine block in the office.<\/p>\r\n\r\n\r\n\r\n

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.<\/p>\r\n\r\n\r\n\r\n

More importantly, what I hope I\u2019ve 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<\/em><\/strong>. One of the dangers of having taught and provided the O-Shot\u00ae 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.<\/p>\r\n\r\n\r\n\r\n

Please help us study and think about this categorically new way to improve the health and function of the female genitourinary tract.<\/p>\r\n\r\n\r\n\r\n

Summary<\/h3>\r\n\r\n\r\n\r\n