Tag Archives: p-shot

When Should You Treat Peyronie’s with the P-Shot® Procedure…Early After Onset, or Later?

Question (name changed)...

Dr. Runels:

I'm an ENT doctor but in this case a urology pt with recent-onset (noticed 2-3 weeks ago) Peyronie's. My urologist ______ in ______ gave me your flier about the Priapus Shot® treatment.

(1) Does your Rx address the plaques?

(2) Does it stop or reverse the Peyronie's process?

(3) Is it better to treat early (now) or wait 8-10 months when the plaques stabilize?

Thank you.

Answer:

(1) Yes! Research shows a decrease in plaque size.
(see research listing below)

(2) If you mean, does the Priapus Shot® procedure help the curvature? Yes, in most men.  If you mean, does it permanently reverse the underlying process so the curvature never recurs...then probably in some. To further elaborate with some data, we did the following research (click to read) with lichen sclerosus (also thought to be an autoimmune process, like Peyronie's), showing that our process with the O-Shot® procedure decreased inflammation according to 2 blinded dermatopothologists--indicating that somehow the procedure down-regulates the autoimmune response.  There are other papers showing this downregulation of the autoimmune process by PRP.

Further as to permanence, our provider group has seen women who see a recurrence of their lichen at 1 year out, a few who are not helped at all, and many who are still well at 3-4 years post procedure. How these data will relate to Peyronie's disease remains to be seen but we expect a similar spectrum.
(see research listing below)

(3) DEFINITELY  better to treat early  before the scar tissue matures. I saw Dr. Virag lecture in Venice this past summer when we shared the podium and he will soon publish data showing that using PRP is more effective and safer than Xiaflex. Depending on how you look at the data, Xiaflex has a 1 in 50 to 1 in 100 risk of fracture/impotence post procedure. The Priapus Shot® procedure has associated with it the probable side effect of an improvement in erection quality by around 5 - 7 on the 25 point scale commonly used.
(see research listing below)

IMPORTANT! If your provider is not on the following list of physicians who have studied the accepted methods of the Priapus Shot® procedure (click) and agreed to follow them, then your physician may be a wonderful provider, but I have no way of knowing who or how he/she was trained and what method he learned. So, I have NO way to make any comments about the quality of the procedure he/she may provide. What I can say, is that your physician (if she/he says he's providing the P-Shot® but is not listed on that directory) is either knowingly or unknowingly breaking the law and pretending to be part of a group that he/she is NOT a part of. The certified providers of the Priapus Shot® procedure share notes with each other, finance research, and support the advancement of the effectiveness of the procedure. THOSE WHO USE THE NAME "PRIAPUS SHOT" BUT WHO ARE NOT LISTED AS ONE OF OUR MEMBERS ARE USING THE FRUITS OF OUR LABORS ILLEGALLY and possibly providing and inferior service by deceiving patients.

Certified Members of the Priapus Shot® Provider Group (click)<--
Research Listings for the Priapus Shot® Protocol for Treating Peyronie's Disease (click to read)<--

Best regards,

Charles Runels, MD

 

Inventor of the Priapus Shot® Procedure

 

Straighter, Harder, Bigger. Step 3. Priapus Shot®

Priapus Shot® Procedure

The Priapus Shot® procedure indicates a specific way of treating the penis with blood-derived growth factors extracted from the man’s own blood (autologous). Some people call these blood-derived growth factors platelet-rich plasma (PRP) but there may be growth factors in plasma we don’t yet know about that do not come from the platelets. The name “Priapus Shot®” is registered with the US Patent & Trademark office as a “service mark” to protect patients by indicating a specific protocol. The name is not a synonym for the injection of blood in to the penis—such a definition would not be specific enough to indicate any particular quality of care. and so would not warrant protection as intellectual property.

The trademark defines a specific method of that providers agree to follow and develop; this agreement offers quality control and is followed and developed by over 500 urologists, interventional radiologists, family practitioners, and internists in multiple countries and by faculty in medical schools where further studies are being done.

The Priapus Shot® procedure protocol also involves patient selection, patient evaluation & education (including explanation of consent), preparation of the PRP, local anesthesia, PRP injection, post injection use of a penis pump on a daily basis, and a daily dose of tadalafil (in come men). Other post injection steps can include: stopping smoking, CoQ10 (12), vitamin E (13), Trimix, and aerobic exercise. Protocol steps vary depending on the patient and those variations also comprise the Priapus Shot® protocol.

Patient selection includes identifying those who may need hormonal treatment, or family counseling, or vascular surgery, as well as those who may have co-morbidities or who may be taking drugs that interfere with sexual function. Some patients are not treated with the Priapus Shot® protocol because another treatment or no treatment is more appropriate.

The policy of most of our providers of the procedure offers a complete refund to any man who is not happy with the Priapus Shot® procedure.

Consulting with the patient includes informing him that unexpected side effects could occur and the results will vary with some patients seeing no benefit. Antibiotics fail in 1 in 5 people in the hospital with pneumonia—resulting in death. Antibiotics “work” but do not work for all people. The same can be said for most all procedures including the Priapus Shot procedure.

The preparation of the PRP involves a device approved by the FDA for isolating PRP from whole blood for autologous use. Since blood is not a drug, it is not governed by the FDA but the devices used to isolate PRP for injection back into the body are regulated by the FDA. Multiple kits have gained FDA approval. Some of the approved kits include Regen, Magellan, TruPRP, Eclipse, Pure Spin, Harvest, & Emcyte. There are over 8,000 research papers on pub med discussing the science of PRP, and not one serious side effect has been documented when FDA approved kits were used to prepare the PRP.

Most men find the procedure very comfortable if a topical lidocaine cream is applied to the penis about 15 minutes prior to the procedure. A very small needle (1/2 inches long, 30 gauge) needle is used for the injection. However, some men do ask for a dorsal nerve block which can easily be done using 2% lidocaine for a near painless procedure (this same block can be used for prosthesis placement—so it makes a 30 gauge needle completely painless for most men.

The Science

An early report that PRP may be useful in the penis appeared in a paper published in Urology in 2003 mentioning that, in animal models, using blood-derived growth factors injected into the penis successfully treated erectile dysfunction and also mentioned that such a strategy may be feasible in men— actually providing a way to correct the underlying pathology (1). In contrast, Viagra and Trimix do not correct the underlying pathology of decreased penile circulation.

Another animal study in 2010 showed that transferring adipocyte derived stem cells (ADSCs) into the penis caused endothelia cell growth (new blood flow) as well as increased nitric oxide activity in the dorsal nerve (harder erection). But, the ADSCs were tagged before injection (to keep up with them) and most of the injected stem cells died! So the improvement seen was not from maturation of the ADSCs but rather from recruitment and activation by growth factors of stem cells already in the body—indicating PRP may demonstrate a similar effect (2).

Dr. Virag (also a pioneer of Trimix injections) published research demonstrating improvement in erectile function, size, and correction of Peyronie’s disease with the use of PRP. His studies both published (and to be published) demonstrate a mean increase of 7 on the ED Intensity Score when PRP is injected into the plaque and into the corpus cavernosum of the human penis (3).

Find Certified Priapus Shot® Provider (click)<==

One of the growth factors found in PRP (over 20 known) includes vascular endothelial growth factor (VEGF). In one animal study, the animals were castrated causing a shutting off of testosterone to create a penis that demonstrated, on microscopy, atrophy of smooth muscle and nerves as well as endothelial cell pathology. Then another group received VEGF injections directly into the corpus cavernosum along with castration. VEGF injection into the penis at the time of castration prevented the atrophy as effectively as did testosterone replacement. Moreover, VEGF reversed cavernosoetric findings of leakage (4).

The above studies and others not cited indicate an improvement in the health, circulation, and strength (density) of penile tissue with injection of blood-derived growth factors into the penis.

What Goes with the Shot?

In regards to improvement in erection firmness, the Priapus Shot® protocol also includes a recommendation of aerobic exercise which by meta analysis of 5 randomized controlled studies using the Erectile Function Scale showed an increase of 5 (5,6).

As previously stated, the complete Priapus Shot® protocol, also includes the use of a penis pump, which as a stand-alone therapy has been demonstrated to improve erection both as part of a penile rehabilitation program as well as an adjunct to other therapies (7,8).

This same penis pump strategy, even without the PRP, has been demonstrated to increase penis size by 2-3 cm, while traction (another physical therapy that can be included as part of the Priapus Shot® protocol) was shown to increase penis length by 1.5-2.5 cm (8, 9). Adding PRP to the protocol shows improved results according to data collected by urologists currently utilizing the Priapus Shot® protocol (to be presented). The 2.5 cm improvement seen with the penis pump alone is in the 10-20% growth range for the average sized penis. As previously stated, while patient results vary, any patients that are not happy with the procedure are given a complete refund.

Ultrasound studies of humans, post treatment, by Dr. Virag and by other physicians who offer the Priapus Shot® protocol demonstrate improved blood flow, an increase in endothelium (improved health), and decreased plaque size. Dr. Joseph Banno of Chicago recently presented a paper showing the Priapus Shot® procedure decreased venous leak as well as increased intra-penile arterial pressure.

Dr. Virag’s studies, using the injection of PRP as a stand-alone (without physical therapies), also demonstrate improvement in the angle of the penis in men suffering with Peyronie’s disease (3). Also, strict adherence to a penis pump regimen is part of the Priapus Shot® protocol and the pump alone improves the angle significantly in over one-half of those studied in one study in the British Journal of Urology (10). This same study demonstrated growth of the penis using the pump alone (without the PRP injection). The PRP alone, in Dr Virag’s study, out-performed the pump with demonstration of remodeling of the plaque. I recommend using both methods: vacuum pump and Priapus Shot®.

Studies show that the non-surgical treatment of Peyronie’s is most effective when a synergy of multiple modalities is engaged (11). So, the Priapus Shot® procedure includes the injection of PRP (demonstrated effective by Dr. Virag) combined with daily physical therapy using a penis pump for ten minutes twice a day and a daily low-dose of taladafil. Other modalities in the Priapus Shot® procedure that have been demonstrated to be synergistic include the following: stopping smoking, CoQ10 (12), vitamin E (13), trimix, and aerobic exercise. Such strategies are not intended to take the place of surgical correction or of the use of chemical surgery with collagenase—but rather to offer the man suffering with Peyronie’s disease the optimal non-surgical treatment as a first step with surgery reserved if non-surgical therapies fail.

The penis pump alone (part of the Priapus Shot® protocol) has been shown to improve the effectiveness of Cialis and of Trimix injections (8). We are seeing men decrease the dosage of Viagra and/or Trimix by about 50 percent when the complete Priapus Shot® protocol is used. The Priapus Shot® protocol does not intend to make any particular therapy obsolete (including surgery) but rather to offer a protocol for enhancing an overall, synergistic approach to correcting penile pathology. However the surgical treatment of Peyronie’s disease can be unsatisfying and lead to serious complications (14); we (the Priapus Shot® providers) are seeing the safety profile of PRP and the Priapus Shot® protocol as offering an appealing conservative and often effective step to take before proceeding to surgery. The risk from PRP is certainly much less than for surgery and less than for collagenase—offering another reason to start with the Priapus Shot® when treating Peyronie’s or erectile dysfunction.

Apply for Certification as Priapus Shot® Provider (click)<==

When considering the duration of effectiveness of the Priapus Shot® procedure and risks involved, you may find it helpful to consider the nature of the cell biology employed. A review article considering the basic science of PRP discusses the fact that the autologous growth factors are exactly what’s generated to propagate healing should the man have surgery. The healing peptides, chemotactic factors, and pluripotent stem cells employed are exactly what’s generated by the normal healing process and offers no inherent risk for infection or allergy (16).

In over 8,000 papers published about PRP on pub med, there is not one serious sequelae reported that I can identify (multiple review articles address safety). This seems logical when you consider the material being injected is autologous and normally produced to help healing and to fight infection.

Wound care studies demonstrate the nature of multiple tissue types being regenerated (with no reported risk of neoplasia in multiple biopsy studies (17-20).

Moreover, in rat studies (where biopsy of the dorsal nerve is feasible), PRP has been shown to help regenerate nerve tissue and restore erectile function when prostate surgery is modeled with crush injury to the dorsal nerve (21,22). Some studies of stem cell therapies demonstrate that the stem cells do not actually mature into healthy tissue but rather signal for the improvement of the involved ganglion and nerve conduction by recruitment of stem cells to the area - exactly what happens with PRP.

Stem cells are not directly prepared as part of the Priapus Shot® procedure, but we are seeing similar results as what’s reported with stem cell studies. Stem Cell studies often use PRP as a carrier for the stem cells, bringing into question which is the active agent (23-24).

The idea of safety is further emphasized by the literature indicating that not only are there no reports of serious allergic reactions to PRP, but research also shows that PRP can attenuate the autoimmune response. One split-scalp study (with placebo control) showed improvement in alopecia areata, with the use of PRP, that out-performed triamcinolone (25). Another study using PRP in the genitalia of women, showed improvement in lichen sclerosus as determined by both patient survey and by 2 blinded dermatopathologists (26). This attribute of PRP (attenuation of the autoimmune response) could partly explain the effectiveness of the Priapus Shot® protocol for the treatment of both Peyronie’s disease and erectile dysfunction since Peyronie’s is thought to be partly caused by an autoimmune response.

Hard & Easy Cases

Hard Cases

  • Penis Growth-Only 60% of men achieve 1/2 inches or more in growth (circumference and length). But, men in that 60% sometimes see up to 1.5 inches in circumference & length (often after 2 to 3 procedures).
  • Men with long-standing vascular disease see less response. If the blood flow going to the penis (ileac arteries) is blocked, then the Priapus Shot® injection into the penis will not help much. The man needs a vascular surgeon. One way to get an idea here….if the man sees absolutely no response when taking Viagra or Cialis for more than 2 years, then he may have blockages or other problems that the Priapus Shot will not help.

Easy Cases

  • Post op for prostate surgery as part of a penile rehabilitation program. If the man could achieve erection before the surgery, the following the Priapus Shot® protocol could be very beneficial (even if it’s been 2 or 3 years since surgery).
  • Improved firmness of erection in the man who can already achieve erection. Typical results are that he may be able to cut the dose of Viagra or Trimix in half (but still need the drug) or if he needs only a low dose of the drugs he may be able to stop using them.
  • Improvement in lichen sclerosus. This is HUGE since lichen sclerosus appears on the foreskin with severe discomfort and often recurs even if the man has a circumcision.
  • Peyronie’s Disease. This possibility is another HUGE benefit of the procedure—with the Priapus Shot® probably safer and more effective than collagenase injections (research to be published soon). If a man undergoes surgery for Peyronie’s disease, the curvature often recurs later since the autoimmune process continues. Also, with surgery, there can be infection and shortening of the penis. None of those side effects have been seen with the Priapus Shot® procedure (side effects include INCREASE in size in most men with Peyronie’s).

Summary

In summary, multiple studies support the idea that blood-derived growth factors (when prepared in a proper way using a kit approved by the FDA for the preparation of PRP), as used in the Priapus Shot® protocol, support the health and function of the penis. Erectile dysfunction is associated with anhedonia, and successful treatment leads to better function, better relationships, and more pleasure in life (27).

Hope you find this helpful!

Peace & health,

Charles Runels, MD
Inventor of the Priapus Shot® Procedure

Apply for Certification as Priapus Shot® Provider (click)<==

Find Certified Priapus Shot® Provider (click)<==

References

1. Siroky M. Vasculogenic erectile dysfunction: newere therapeutic strategies. J Urol. 2003;170(2 Pt 2):S24-9.

2. Garcia MM, Fandel TM, Lin G, Shindel AW, Banie L, LinC-S, and Lue TF. Treatment of erectile dysfunction in the obese type 2 diabetic ZDF rat with adipose tissue-derived stem cells. J Sex Med 2010;7:89–98

3. Virag R. A New Treatment of Lapeyronie’s Disease by Local Injections of Plasma Rich Platelets (PRP) and Hyaluronic Acid. Preliminary Results. e-mémoires de l'Académie Nationale de Chirurgie. 2014;13(3):96-100.

4. Rogers R. Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. International Journal of Impotence Research. 2003;15:S24-9.

5. Lamina S, Agbanusi E, Nwacha RC. Effects of Aerobic Exercise in the Management of Erectile Dysfunction: A Meta Analysis Study on Randomized Controlled Trials. Ethiopian Journal of Health Sciences. 2011;21(3):195-201.

6. Esposito K, Giugliano F, Di Palo C, et al. Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial. JAMA. 2004;291(24):2978-2984. doi:10.1001/jama.291.24.2978.

7. Nikolai S. Erection rehabilitation following prostatectomy--current strategies and future directions. Nature Reviews Urology. 2016;13(.):216-225.

8. Pahlajani G,Raina R, Jones S, Ali M, and Zippe C. Vacuum erection devices revisited: Its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy. J Sex Med 2012;9:1182–1189.

9. Sellers T, Dineen M, Wilson SK. Vacuum protocol and cylinders that lengthen allow implantation of longer, inflatable prosthesis. Toronto, ON: (Abst) Society of Sexual Medicine; 2008.

10. Raheem A. The role of vacuum pump therapy to mechanically straighten the penis in Peyronie's disease. BJU Int.. 2016;117(4):E7.

11. Levine L. Peyronie’s disease: contemporary review of non-surgical treatment. Transl. Androl. Urol. 2013;2(1):39-44.

12. Safarinejad M. Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie’s disease: a double-blind, placebo-controlled randomized study. International Journal of Impotence Research. 2010;22(5):298-309.

13. Paulis G. Efficacy of vitamin E in the conservative treatment of Peyronie's disease: legend or reality? A controlled study of 70 cases. Andrology. 2013;1(1):120-128.

14. Lue T. The Challenges of Peyronie's disease. Translational Andrology & Urology. 2012;1(S1):PS 9.

15. Raynor M. Dorsal Penile Nerve Block Prior to Inflatable Penile Prosthesis Placement: A Randomized, Placebo‐Controlled Trial. The Journal of Sexual Medicine. 2012;9(11):2975-2979.

16. Sanchez-Gonzales J. Platelet-Rich Plasma Peptides: Key for Regeneration. International Journal of Peptides. 2012;10:1-10.

17. Taylor D. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries.. Clin J Sport Med. 2011;21(4):344-52.

18. Yuan T, Zhang C-Q, Wang JH-C. Augmenting tendon and ligament repair with platelet-rich plasma (PRP). Muscles, Ligaments and Tendons Journal. 2013;3(3):139-149.

19. Sell S. A case report on the use of sustained release platelet-rich plasma for the treatment of chronic pressure ulcers. The Journal of Spinal Cord Medicine. 2011;34(1):122-7.

20. Conde-Montero, E., Horcajada-Reales, C., Clavo, P., Delgado-Sillero, I. and Suárez-Fernández, R. (2014), Neuropathic ulcers in leprosy treated with intralesional platelet-rich plasma. Int Wound J. doi:10.1111/iwj.12359

21. Ding X. The effect of platelet-rich plasma on cavernous nerve regeneration in a rat model.. Asian J Androl. 2009;11(2):215-21.

22. Ding X. Platelet-rich plasma on the Cavernous Nerve Regeneration. Chinese Medical journal. 2008;88(36):2578-2580.

23. Rene' Y. Safety of Intracavernous Bone Marrow-Mononuclear Cells for Postradical Prostatectomy Erectile Dysfunction: An Open Dose-Escalation Pilot Study. European Urology. 2016;69(6):988-991.

24. Fandel T. Recruitment of Intracavernously Injected Adipose-Derived Stem Cells to the Major Pelvic Ganglion Improves Erectile Function in a Rat Model of Cavernous Nerve Injury. European Urology. 2012;61(1):201-210.

25. Singh S. Role of platelet-rich plasma in chronic alopecia areata: Our centre experience.. Indian Journal of Plastic Surgery. 2015;48(1):57-9.

26. Goldstein A. ISSVD 2015 Abstracts. Autologous Platelet Rich Plasma (PRP) Intradermal Injections for the Treatment of Vulvar Lichen Sclerosus. Journal of Lower Genital Tract Disease. 2015;19(3):S1-S25.

27. Goldstein A., Runels C. Intradermal Injection of autologous platelet-rich plasma for the treatment of vulvar Lichen sclerosus. Journal of the American Academy of Dermatology. 2017;76(1):158-160

27. Zaman H. Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction. Patient Preference and Adherence. 2016;10:807.

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Peyronie’s & ED Treatment: The Priapus Shot® Procedure

Priapus Shot® Procedure

The Priapus Shot® procedure indicates a specific protocol for treating the penis with blood-derived growth factors: specifically platelet-rich plasma or PRP. The name Priapus Shot® is registered with the US Patent & Trademark office as a “service mark” to protect patients by indicating a specific protocol. The name is not a synonym for the injection of blood in to the penis—such a definition would not be specific enough to warrant protection as intellectual property and so would not indicate any particular quality of care.

The trademark gives a method of teaching a specific protocol that providers agree to follow and develop; this agreement offers a measure of quality control and is being followed and developed by around 500 urologists and interventional radiologists, family practitioners, and internists in multiple countries and by faculty in several medical schools where further studies are being done.

The Priapus Shot® procedure defines a protocol that involves patient selection, patient evaluation & education (including explanation of consent), preparation of the PRP, local anesthesia, PRP injection, post injection use of a penis pump on a daily basis, and a daily dose of Tadalafil. Other post injection steps can include: stopping smoking, CoQ10 (12), vitamin E (13), Trimix, and aerobic exercise. Protocol steps can vary depending on the problems presented by the patient.

It is the policy of most of our providers of the procedure to offer any patient that is not happy with the Priapus Shot® procedure a complete refund.

Find Priapus Shot® Provider <--

Patient selection includes identifying those who may need hormonal treatment, or family counseling, or vascular surgery, as well as those who may have co-morbidities or who may be taking drugs that interfere with sexual function. Some patients are not treated with the Priapus Shot® protocol because another treatment or no treatment is more appropriate.

Consulting the patient includes informing him that unexpected side effects could occur and the results can vary with some patients seeing no benefit.

The preparation of the PRP involves a device approved by the FDA for isolating PRP from whole blood for autologous use. Since blood is not a drug, it is not governed by the FDA. Multiple kits have gained FDA approval. Some of the approved kits include Regen, Magellan, TruPRP, Eclipse, Pure Spin, & Emcyte. There are over 8,000 papers on pub med discussing the science of PRP, and not one serious side effect has been documented when FDA approved kits were used to prepare the PRP.

The first indication that PRP may be useful in the penis is in a paper published in Urology in 2003 indicating that, in animal models, using growth factors was successful to treat erectile dysfunction and indicated that such a strategy may be feasible in men— actually providing a way to correct underlying pathology (1). Viagra and Trimix do not correct underlying pathology of penile circulation.

Another animal model study in 2010 showed that transferring adipocyte derived stem cells (ADSCs) into the penis caused endothelia cell growth as well as increased nitric oxide activity in the dorsal nerve. Interestingly, the ADSCs were tagged and perished - so the improvement seen was not from maturation of the ADSCs but rather from recruitment and activation by growth factors of stem cells from within the body. Also, indicating the PRP may demonstrate a similar effect (2).

Dr. Virag (also a pioneer of Trimix injections) published a paper demonstrating improvement in erectile function, size, and correction of Peyronie’s disease with the use of PRP. His studies both published (and to be published) demonstrate a mean increase of 7 on the ED Intensity Score when PRP is injected into the plaque and the corpus cavernosum of the human penis (3).

One of the growth factors (over 20 known) found in PRP includes vascular endothelial growth factor (VEGF). In one animal model study, the animals were castrated to create a penis that demonstrated, on microscopy, atrophy of smooth muscle and nerves as well as endothelial cell pathology. Injecting VEGF directly into the corpus cavernosum prevented the atrophy as effectively as did testosterone replacement. Moreover, VEGF reversed cavernosoetric findings of leakage (4).

The above studies and others not cited indicate an improvement in the health, circulation, and strength (density) of penile tissue.

In regards to improvement in erection firmness, the Priapus Shot® protocol also includes a recommendation of aerobic exercise which by metaanalysis of 5 randomized controlled studies using the IIEF showed an increase of 5 (5,6).

As previously stated, the complete Priapus Shot® protocol, also includes the use of a penis pump, which as a stand-alone therapy has been demonstrated to improve erection both as part of a penile rehabilitation program as well as an adjunct to other therapies (7,8).

This same penis pump strategy, even without the PRP, has been demonstrated to increase penis size by 2-3 cm, while traction (another physical therapy that can be included as part of the Priapus Shot® protocol) was shown to increase penis length by 1.5-2.5 cm (8, 9). Adding PRP to the protocol shows improved results according to data collected by urologists currently utilizing the Priapus Shot® protocol - to be presented later this year. It should be noted that the 2.5 cm improvement seen with the penis pump alone is in the 10-20% growth range for the average sized penis. As previously stated, while patient results vary, any patients that are not happy with the procedure are given a complete refund.

Ultrasound studies of humans, post treatment, by Dr. Virag and by the physicians currently utilizing the Priapus Shot® protocol demonstrate improved blood flow and an increase in endothelium (improved health) as well as such results being indicated animal model studies, only some of which have been cited.

Dr. Virag’s studies, using the injection of PRP as a stand-alone (without physical therapies), also demonstrate improvement in the angle of the penis in men suffering with Peyronie’s disease (3). Also, strict adherence to a penis pump regimen is part of the Priapus Shot® protocol and the pump alone improves the angle significantly in over one-half of those studied in one study in the British Journal of Urology (10). This same study demonstrated growth of the penis using the pump alone (without the PRP injection) though the growth was not as significant as in the other studies previously cited. The PRP alone, in Dr Virag’s study, out-performed the pump with demonstration of remodeling of the plaque.

Studies show that the non-surgical treatment of Peyronie’s is most effective when a synergy of multiple modalities is engaged (11). So, the Priapus Shot® procedure includes the injection of PRP (demonstrated effective by Dr. Virag) combined with daily physical therapy using a penis pump for ten minutes twice a day and a daily low-dose of Taladafil. Further, other modalities are also used in the Priapus Shot® procedure that have been demonstrated to be synergistic: stopping smoking, CoQ10 (12), vitamin E (13), Trimix, and aerobic exercise. Such strategies are not intended to take the place of surgical correction or of the use of chemical surgery with collagenase—but rather to offer the man suffering with Peyronie’s disease the optimal non-surgical treatment as a first step with surgery reserved if non-surgical therapies fail.

The Priapus Shot® protocol does not intend to make any particular therapy obsolete but rather offer a protocol for enhancing an overall, synergistic approach to pathology of the penis. The surgical treatment of Peyronie’s disease can be unsatisfying and lead to serious complications (14); we are seeing the safety profile of PRP and the Priapus Shot® protocol offer an appealing conservative step to take before proceeding to surgery.

For, example the penis pump alone (part of the Priapus Shot® protocol) has been shown to improve the effectiveness of Cialis and of Trimix injections (8). We are seeing men decrease the dosage of Viagra and/or Trimix by about 50 percent when the complete Priapus Shot® protocol is used.

Most men find the procedure very comfortable if a topical lidocaine cream is used since a 1/2 inch 30 gauge needle is used for injection (similar to a Trimix injection). However, some men do ask for a dorsal nerve block which can easily be done using 1% lidocaine without epinephrine for a near painless procedure (since this same block can be used for prosthesis placement, it makes a 30 gauge needle completely painless for most men) (15).

Considering the duration of effectiveness and risks involved it’s useful to consider the nature of the cell biology employed. A review article considering the basic science discusses the fact that the autologous growth factors are exactly what’s generated to propagate healing should the man have surgery. The healing peptides, chemotactic factors, and pluripotent stem cells employed are exactly what’s generated by the normal healing process and offered no inherent risk for infection or allergy (16).

In over 8,000 papers published about PRP on pub med, there is not one serious sequelae reported that I can identify (multiple review article speaks of the safety). This seems logical when you consider the material being injected is autologous and normally produced to help healing and to fight infection.

Wound care studies demonstrate the nature of multiple tissue types being regenerated (with no reported risk of neoplasia in multiple biopsy studies (17-20).

Moreover, in rat studies (where biopsy of the dorsal nerve is feasible), PRP has been shown to help regenerate nerve tissue and restore erectile function when prostate surgery is modeled with crush injury to the dorsal nerve (21,22). Some studies of stem cell therapies demonstrate that the stem cells do not actually mature into healthy tissue but rather signal for the improvement of the involved ganglion and nerve conduction by recruitment of stem cells to the area - exactly what happens with PRP.

Stem cells are not directly prepared as part of the Priapus Shot® procedure, but we are seeing similar results as what’s reported with stem cell studies. Stem Cell studies often use PRP as a carrier for the stem cells, bringing into question which is the active agent (23-24).

The idea of safety is further emphasized by the literature indicating that not only are there no reports of serious allergic reactions to PRP, but research also shows that PRP can attenuate the autoimmune response. One split-scalp study (with placebo control) showed improvement in alopecia areata, with the use of PRP, that out-performed triamcinolone (25). Another study using PRP in the genitalia of women, showed improvement in lichen sclerosus as determined by both patient survey and by 2 blinded dermatopathologists (26). This attribute of PRP, that of attenuation of the autoimmune response, could partly explain the effectiveness of the Priapus Shot® protocol for the treatment of both Peyronie’s disease and erectile dysfunction.

In summary, multiple studies support the idea that blood-derived growth factors (when prepared in a proper way using a kit approved by the FDA for the preparation of PRP), as used in the Priapus Shot® protocol, support the health and function of the penis. Erectile dysfunction is associated with anhedonia, and successful treatment leads to better function, better relationships, and more pleasure in life (27).

References

1. Siroky M. Vasculogenic erectile dysfunction: newere therapeutic strategies. J Urol. 2003;170(2 Pt 2):S24-9.

2. Garcia MM, Fandel TM, Lin G, Shindel AW, Banie L, LinC-S, and Lue TF. Treatment of erectile dysfunction in the obese type 2 diabetic ZDF rat with adipose tissue-derived stem cells. J Sex Med 2010;7:89–98

3. Virag R. A New Treatment of Lapeyronie’s Disease by Local Injections of Plasma Rich Platelets (PRP) and Hyaluronic Acid. Preliminary Results. e-mémoires de l'Académie Nationale de Chirurgie. 2014;13(3):96-100.

4. Rogers R. Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. International Journal of Impotence Research. 2003;15:S24-9.

5. Lamina S, Agbanusi E, Nwacha RC. Effects of Aerobic Exercise in the Management of Erectile Dysfunction: A Meta Analysis Study on Randomized Controlled Trials. Ethiopian Journal of Health Sciences. 2011;21(3):195-201.

6. Esposito K, Giugliano F, Di Palo C, et al. Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial. JAMA. 2004;291(24):2978-2984. doi:10.1001/jama.291.24.2978.

7. Nikolai S. Erection rehabilitation following prostatectomy--current strategies and future directions. Nature Reviews Urology. 2016;13(.):216-225.

8. Pahlajani G,Raina R, Jones S, Ali M, and Zippe C. Vacuum erection devices revisited: Its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy. J Sex Med 2012;9:1182–1189.

9. Sellers T, Dineen M, Wilson SK. Vacuum protocol and cylinders that lengthen allow implantation of longer, inflatable prosthesis. Toronto, ON: (Abst) Society of Sexual Medicine; 2008.

10. Raheem A. The role of vacuum pump therapy to mechanically straighten the penis in Peyronie's disease. BJU Int.. 2016;117(4):E7.

11. Levine L. Peyronie’s disease: contemporary review of non-surgical treatment. Transl. Androl. Urol. 2013;2(1):39-44.

12. Safarinejad M. Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie’s disease: a double-blind, placebo-controlled randomized study. International Journal of Impotence Research. 2010;22(5):298-309.

13. Paulis G. Efficacy of vitamin E in the conservative treatment of Peyronie's disease: legend or reality? A controlled study of 70 cases. Andrology. 2013;1(1):120-128.

14. Lue T. The Challenges of Peyronie's disease. Translational Andrology & Urology. 2012;1(S1):PS 9.

15. Raynor M. Dorsal Penile Nerve Block Prior to Inflatable Penile Prosthesis Placement: A Randomized, Placebo‐Controlled Trial. The Journal of Sexual Medicine. 2012;9(11):2975-2979.

16. Sanchez-Gonzales J. Platelet-Rich Plasma Peptides: Key for Regeneration. International Journal of Peptides. 2012;10:1-10.

17. Taylor D. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries.. Clin J Sport Med. 2011;21(4):344-52.

18. Yuan T, Zhang C-Q, Wang JH-C. Augmenting tendon and ligament repair with platelet-rich plasma (PRP). Muscles, Ligaments and Tendons Journal. 2013;3(3):139-149.

19. Sell S. A case report on the use of sustained release platelet-rich plasma for the treatment of chronic pressure ulcers. The Journal of Spinal Cord Medicine. 2011;34(1):122-7.

20. Conde-Montero, E., Horcajada-Reales, C., Clavo, P., Delgado-Sillero, I. and Suárez-Fernández, R. (2014), Neuropathic ulcers in leprosy treated with intralesional platelet-rich plasma. Int Wound J. doi:10.1111/iwj.12359

21. Ding X. The effect of platelet-rich plasma on cavernous nerve regeneration in a rat model.. Asian J Androl. 2009;11(2):215-21.

22. Ding X. Platelet-rich plasma on the Cavernous Nerve Regeneration. Chinese Medical journal. 2008;88(36):2578-2580.

23. Rene' Y. Safety of Intracavernous Bone Marrow-Mononuclear Cells for Postradical Prostatectomy Erectile Dysfunction: An Open Dose-Escalation Pilot Study. European Urology. 2016;69(6):988-991.

24. Fandel T. Recruitment of Intracavernously Injected Adipose-Derived Stem Cells to the Major Pelvic Ganglion Improves Erectile Function in a Rat Model of Cavernous Nerve Injury. European Urology. 2012;61(1):201-210.

25. Singh S. Role of platelet-rich plasma in chronic alopecia areata: Our centre experience.. Indian Journal of Plastic Surgery. 2015;48(1):57-9.

26. Goldstein A. ISSVD 2015 Abstracts. Autologous Platelet Rich Plasma (PRP) Intradermal Injections for the Treatment of Vulvar Lichen Sclerosus. Journal of Lower Genital Tract Disease. 2015;19(3):S1-S25.

27. Goldstein A., Runels C. Intradermal Injection of autologous platelet-rich plasma for the treatment of vulvar Lichen sclerosus. Journal of the American Academy of Dermatology. 2017;76(1):158-160

27. Zaman H. Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction. Patient Preference and Adherence. 2016;10:807.

Size

3 Questions about the Priapus Shot® Procedure

  1. P-Shot® increase size much? With or without the pump?
  2. Other methods for size- pump work alone? If so how to use and for how long etc?
  3.  Physical techniques using the hands or traction?

Podcast Answer.
Consult your doctor before doing anything & before stopping anything your doctor told you to do...

Related Links...

Transcription of Podcast

Question 1: Does the P-Shot® increase the size much and with or without the penis pump?

First of all, what's much?

If you take the average-sized penis of 6" in length and you increase the circumference by 1 inch (2.5 cm), then you double the volume of the penis!

That's not enough that you're going to make a shocking display on the next porn movie, but it's definitely enough that your lover will be able to feel the difference.

Starting Point

First of all, nothing is 100% especially the Priapus Shot® procedure for size. I am first to tell you that it is very frustrating when I get a phone call from someone like I did a few months ago; a fellow tells me that his full erection is 2 inches long—2 inches long! His full erection is only 5 cm long and he's never been alone with a woman because he's embarrassed by the size of his penis.

With this man, the size of his penis is NOT just about being proud of his penis in the shower. He suffers with a social problem. Unfortunately, I cannot offer him a guaranteed solution. Just like with muscles, it appears that the more you have, the easier it is to grow. You can watch a guy who's already muscular and when he goes to the gym his biceps grow like crazy, while the man with little muscle tone struggles to increase arm size and strength.

The people who come to me who have a 6 inch penis, it's easier for them to grow to 7, than it is for the fellow with a 3 inch erection to grow to a 4.

I wish it weren't so, but my suspicion is that with the muscles and with the penis the results involve many factors (some not so obvious). But, what appears plain is that when we’re talking about cellular growth, then the more you start with, the more easily you’ll see noticeable growth—because it’s a percentage results based on your baseline cellular mass when you start.

Nutrition & Growth

In addition to starting cell mass, other factors affecting growth include nutrition.

Poisons to Growth

Also, will the toxins from cigarette smoking be poisoning the new growth (why many surgeons won't do a face lift if the person smoked cigarettes with a week or two prior to surgery).

The same process that results in wound healing after surgery works as the way the penile tissue responds to the Priapus Shot® procedure—cellular growth & if the tissue struggles because of toxins, then it's not going to grow.

Method of Preparing & Injecting

Another factor that affects the results of the Priapus Shot® procedure is the method by which the procedure is done. Does the person doing the shot use equipment approved by the FDA for the preparation of PRP in a method that makes the PRP sterile enough to go back into the body and does the kit actually isolate an adequate concentration of PRP. Multiple attorneys work with us around the world to shut down physicians and non-physicians who claim to be doing the Priapus Shot® procedure but who do not understand the method of injecting or the method of preparing the PRP. You may think that’s a rare occurrence, but it’s not.

You can find a certified provider here (click)<—

If you’re a physician or physician extender, you can apply to become one of our providers here (click)<—

Not only has is the platelet plasma made, but does the person understand where to put the plasma, how to inject it into the corpus cavernosum of the penis?

What’s Possible with the Priapus Shot® Procedure?

Somewhere around 60% of the people across the world, (around 70% in my practice) see growth of the penis that's a half an inch or more (that’s in circumference and in length).

I treated 2 men who swore they grew 2 inches in length and 2 inches in circumference. I saw quite a few who grew an inch to an inch and a half, but routinely, after the first procedure, you'll see a full half an inch in circumference and then another half an inch in length. The circumference appears first (within 2-3 weeks) and then the length appears after that (within 6-12 weeks).

Does it “work” every time? Can you guarantee results?

To understand how medicine works, consider antibiotics for people suffering with pneumonia in the hospital. That's a severe thing. One out of five of those people, 20% of people in the hospital with pneumonia die even on IV antibiotics, even with simultaneous dosing of our most strong, antibiotics-the infection kills them.

So, there's only an eight out of ten success rate with antibiotics for pneumonia in the hospital, but do antibiotics work?

Of course, they work! Just because 20% of the people who take them for pneumonia in the hospital still die from pneumonia doesn't mean that antibiotics don't work—they do work for 80% of people!

Should we quit using antibiotics for people because the antibiotics “don’t work” for some people? Are doctors tricking patients when they try to get people suffering with pneumonia well with antibiotics? Of course not!

But, sometimes I’ll get an email from someone who says the Priapus Shot didn't work! I was “ripped off!”

When I get emails like this, it makes me sad because I’m imagining a man who may suffer with sex & relationship problems and feel angry because he’s not yet well. I always want to help but because sexual function involves so many factors (with the penis, endocrine system, circulatory system, orgasm system, neurological system, psychology, social relations to his lover, & much more), there is no way for me to tell from an email or even a phone call what to do. All of these factors should be considered by the healer who is able to see the man on multiple occasions and to do a physical exam. He may even need a TEAM of providers to help guide him back to excellent physical and sexual health.

Some simple things to ask include the following:

Do you smoke ciagarettes?
Do you smoke pot?
Do you use narcotics for pain or recreation?
Do you take blood pressure medicine?
Is your testosterone too low?
Is your growth hormone too low?
Do you have a high estradiol level?
Is your prolactin too high? (In the recording, I erroneously say “too high.”)
Is your nutrition adequate?
Is your blood flow down because you're suffering with Type 2 diabetes and uncontrolled hyperglycemia?
There's so many things that can go on to explain why the Priapus Shot® “didn’t work.”

Also, why did you get the Priapus Shot? Was it for growth?

Was it for erectile dysfunction, Peyronie’s, lichen sclerosus, post op for prostate surgery, or to grow your penis in length or girth?

The success rate varies tremendously depending upon why you were treated and on all the cofactor discussed.

Do weight lifts work for muscle growth? Of course, they do, but some people lift weights their whole life and still never really get that strong or big. Others, they're genetically inclined to larger muscles and so they seemassive growth when they lift weights.

Your possibility for most strength and size of musculature happens if you do lift weights. If you want ultimate growth of your muscles, then you would lift weights.

What else might you do to grow bigger & stronger muscles?

You would use anabolic steroids!

Would Arnold look like Arnold if he weren't genetically endowed-an Austrian man with an excellent bone structure?

Absolutely not.

Would he look like Arnold if he never used anabolic steroids?

Absolutely not!

He very says that he used large doses of anabolic steroids. Back in his days of Mr. Olympia competitions, in the '70s, anabolic steroids were treated almost like antibiotics. Your pharmacist would just almost give them to you without a prescription.

They weren't controlled (like a narcotic) by the DEA until the 1990s.

Also, along those same lines, physicians did not think (in the formal medical literature) that bodybuilders were actually strong! They thought that the body builders just added “water weight.” Of course, they were stronger.

In the late 1980s, the medical research finally stated that the combination of weights plus anabolic steroids do make you stronger—much stronger! Your strongest self happens when you combine the two. Arnold because Arnold not because of genetics, because of anabolic steroid, or because of gut-wrenching, vomiting-because-of-effort workouts. He became Arnold & Mr Olympia 7 times because of all 3 of those combined!

If you talk to NFL players, they'll say, "Yeah, there's only two kinds of NFL players. Those who use anabolic steroids and those who lie about it." I don't know how true that is, but that's what I hear when I talk to NFL athletes.

Back to penis growth and a second question.

Do other methods work along with the Priapus Shot® and does the pump work alone?

Do weights work alone for muscles?

Yes, they do.

Do they work for everybody significantly?

No, they don't.

Do weights work better if you have growth hormones and steroids involved?

Yes, they do.

What's in platelet rich plasma?

One of the hormones in platelets is IGF-1 or somatomedin C, which is the active hormone we think that results from people who use growth hormone.

Growth hormone results in somatomedin C formation (also called insulin-like growth factor 1 or IGF-1) by the liver and other tissues.

That exact same growth factor (IGF-1) is released from platelets. When platelets are injected with a Priapus Shot® procedure.

Then, when you use the pump along with the Priapus Shot®, you're basically lifting weights and using steroids with your penis.

If the pump works, then how should I use it and for how long?

I have a link here (click) that takes you to a whole video and a whole transcript that gives you details about how to use the pump. There, I give you details that go along with research about how the pump works alone (without the Priapus Shot).

There you’ll find a paper showing growth with the pump alone—research published by the British Journal of Urology showing growth and straightening of the penis with a pump alone. In the study, men suffered with severe Peyronie's disease (enough that they planned surgery). Over half of them, canceled their surgery after 12 weeks of using a penis pump alone.

Physical techniques using the hands or traction, do they work?

Anything physical with the penis is going to “work” if performed intelligently. The problem with the hand is you can't as accurately judge what pressure you're applying (with the pump, you can use a pressure gauge). Risk for lack of efficacy and for significant side effects increase with inconsistent application of traction and pressure.

More significantly, in seeing thousands of men in my office, for every one person I've seen who increased the size of their penis by jelqing (which is another word for using your hand) or by using a traction device, I saw 50 men who reported to me that they saw a growth of their penis using a pump.

Use a pump (with your doctor’s supervision) and you use it the way I describe on the video (click).

Pump Ideas

What makes the penis growth from a pump?

How does the penis decide how big to be?

It's a physics problem—think of a water balloon.

A balloon (including the penis) stops growing when the pressure inside equals the combined pressure of the atmosphere outside and the tensile or stretch on the wall of the penis (a mathematical model for the collective connective tissue of the penis).

If you're using your pump regularly, it just makes sense, just like if you stretch out a balloon, it becomes easier to blow it up, but also because of the tensile strength of the wall becomes less, it equalizes at a greater size.

That's the physics of it. So first the tensile strength from the penis goes down. Then the Priapus Shot helps with repair and growth.

If you lift weights, then you repair, then you lift weights again, then you see growth of muscles. And, If you lift weights too much, there's damage.

You can use that same idea to grow the penis.

Follow the guidelines here (click)<—.

Some of the growth from the pump can also be edema. When you use the pump for a significant time (even at 10 or 15 minutes), you may see that fluid comes out of the intravascular space into the extravascular space (leaves the blood vessels to fill the tissue outside the blood vessels). You can even see this edema under the skin when your erection goes flaccid. There's no harm from the edema.

Sometimes, after weeks of using a penis pump, you might see some darkening of the skin of the penis. That color change tends to reverse if you stop pumping or quit pumping on a daily basis.

Summary

Any time there's significant growth of a physical biological structure (your finger, your hair, your face, your penis, your nose, whatever), for true growth, you must cause cell growth by either enlargement of the individual cells or by proliferation in the numbers of the cells.

That cellular growth happens in multiple other tissues: straightening bone or elongating bone, in some orthopedic injuries with traction devices & with soft tissues like the nose or the ears.

We know that the combination of physical therapies with hormonal or biological therapies affect the most significant growth (rather than either one alone).

And, we know that growth varies with multiple factors about which some of we know and about which some we continue to be completely ignorant.

I hope this is helpful. There is no 100% satisfaction with any procedure. What I can promise you is that the combination of all the factors that go in with health and with a healthy penis that are covered in my materials and those who are the other Priapus Shot® providers will be a good chance at your best penis.

Just like exercising and good nutrition and all that goes with the growth of the rest of your body— whether it’s growing muscles, or growing heart, or growing vasculature when you exercise— will achieve your best overall aerobic health and personal musculature strength, in the same way, following these therapies will achieve your best penis.

I wish you the best and I hope these ideas help you.

Peace & health,

Charles Runels, MD
888-920-5311

 

 

 

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Peyronie’s & ED Treatment…”Supplements & Foods that Cause a Harder Straighter Erection”…


(scroll down to read transcript of this video)

Priapus Shot Providers (click) <--

Resources & References (Video Explains)...

    • Pycnogenol

        


  • Double blind study of Co-Q10 (click to read)<--
    • 186 men with "early chronic" Peyronie's got 300mg Co-Q10 per day. The other group got placebo.
    • No other treatment!
    • At the end of 6 months...
      • Placebo group-average plaque size and curvature increased. 56% of the men in the group were worse. No one was better.
      • In the men who took 300mg Co-Q10, average plaque size and curvature improved and erectile function improved! Only 13.6% of the men worsened.
    • Conclusion. Co-Q10 prevents worsening 87% of the time, and improves curvature & erectile function & decreases plaque size in most men after 6 months of treatment.
    • Recommended Co-Q10. This is a 6 month supply of high quality in 1 bottle. Put this buy where ever you have your morning meal or protein shake and take with that....

      


  • Vitamin E used in combination with other therapies. (Click to read)<--
    • Men with Peyronie's were divided into 2 groups and treated for 6 months.
      • In 1/2 of the men, vitamin E  at a does of 1,200 IU was give once a day as part of a combination therapy.
      • The other 1/2 got the combination therapy without the vitamin E
    • The men who did not get the vitamin E saw and average decrease in curvature of 6 degrees. Average reduction in plaque was 36%. Of the men treated, 48% improved.
    • With the men who DID get vitamin E, an average decrease in curvature of twice as much occurred--12%. The average plaque reduction was 50% and of the men treated 96% improved!
    • No one in the vitamin E group saw a worsening of the curvature or an increase in the size of the plaque. Some of the men who did not take vitamin E did see an worsening of the curvature with 17% of them seeing an increase in the size of the plaque!
    • The vitamin E group also saw a more significant increase in erectile function.
    • This is a wonderful example of the "fire" analogy. Sometimes it takes more than  1 thing a the same time to build a fire.
    • One of each of these per day gives 1,250 IU's (1,000 + 250) with an excellent quality and a few cofactors that help the E work better...

         <--one of these + one of these-->

Beginning of Transcript of Webinar...

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Dr Runels: So thank you guys for coming. There's this idea by some people that whatever you have with your erection, you can only make things better by taking medicines, and that the blood flow through the penis itself can't be improved, but as a matter of fact it can be improved, and there's research dating back at least the past 15, 20 years demonstrating that that is possible. Before, there was a Priapus Shot®.

So as we go through this, I'll just run through this and lay down the research the best I understand it. There may be some other physicians on the phone here, actually I see several other physicians on the phone, and so at some point I'll open the floor for discussion and I'll also open the phone of some of the other physicians so that we can answer your questions.

After spending years, 25 plus years taking care of people, and intensively studying for the past few years ways to make the erection better specifically, other than things ... if you think about it, if you take Viagra, that's a great drug, but it's not doing anything to correct the problem, it's just making what's there work harder. Same with an implant, but the idea of actually making the blood flow itself into the penis better is what we're talking about here.

Some of you may be on this call because you subscribe to this newsletter here where I intend to put down what I determined from the medical literature to be things that have been proven to be helpful, like hormones, exercise, of course our priapus shot, nutrition, using a pump, so today's topic is about the pump, and we'll go to the sort of an outline, and I haven't made this page available yet, but here are some of the most powerful things I've seen, and a lot of this, this comes from a lot of research, but much of what I'll show you is summarized in a paper that you'll find a link to on the page right here, and when you click on that it takes you there. I'll tell you how to get to this page after the webinar, and I'll post a recording of this right there at the top of the page so you can review it.

If you click on that, it takes you to this excellent review article that goes into all the things that have been demonstrated in the way of lifestyle and eating and supplements to improve the erection and how that works. So the most powerful one is exercise. I hate to say it, some people hate exercise, but so important that I'll cover that in a separate webinar.

But getting to the supplements, folic acid, antioxidants, calcium I think is less helpful, vitamin C, vitamin E, and again hormones will be covered in another episode. Now when it comes to the antioxidants what I've observed and others, and what the research shows is that C and E are helpful, and even for Peyronie's disease there's a double-blind, placebo controlled study that I've posted, showing that, if you go to this part here about vitamin E and click on this, there was a double-blind ... this showed that using the vitamin E helped Peyronie's disease.

Also there was a study here with CoQ10 where they took 196 men with early chronic Peyronie's and gave them 300 mg of CoQ10 per day, and no other treatment, and then at the end of the six months, the people who were taking the placebo on average saw a worsening, and no one was improved, but in the people who took the coq10, the plaque size improved on average and only 13 percent of them worsened. This was a true placebo controlled study.

All of the studies show that there's a synergy, there's an actual synergy, so what I see, and this is a huge problem I think, is that people will try one thing and they think that doesn't work, so they discard it instead of adding that one thing to the other things. My favorite analogy with that is starting a fire. If someone told you, and you had no idea what a fire is, told you to light a match, you wouldn't see very much, so you decided okay, matches don't work. And the next day someone told you that you should use wood, pile up a bunch of wood, but alone of course that wouldn't do much for a fire. Someone says, okay really what you need to make a fire is a stack of wood, put some lighter fluid on it, and then light a match, then you would have a real fire.

This is what you're looking at, this picture is the match that starts the erection fire of improved erectile function in your penis. The way this works is that nitric oxide, neuronal nitric oxide synthase relaxes the arteries, so the things that promote neuronal nitric oxide are these, and you have to have the right dose, at least enough of the stuff.

Vitamin C I like at least three grams a day with food, vitamin E at least 1250 mg, that's what's in the research. Now, let's go and look at arginine and citrulline, because that's very interesting, if you look at what he writes about here, he said there was no effect at all at the lower dose of one and a half grams per day. That's a big tablet, most people have trouble swallowing a tablet that's more than one gram. But in a randomized trial of five grams per day, there was improvement in 31% of the men.

What I recommend is arginine or glutamine at four grams, three times a day, twelve grams a day. If you take that in tablets it gets to be very expensive, so what I recommend you do is buy it in a powder and taking that many pills will exhaust you, so I recommend that you mix the powder with water. Now, hang with me here, because it does no good in my opinion to look at all this research. As a matter of fact, I don't like looking at research unless there's a way to actually use it to make people healthier.

I like the science piece of it, sometimes it's interesting, but if I can't tell you exactly what to do to make your life better and your erections better, then it's a waste, you might as well be watching the news. So I'm telling you how to implement this. Everything on here is going to be exactly how to do it.

So arginine. Not only does arginine help with nitric oxide production, but what he doesn't say right here is arginine and glutamine both, taken on an empty stomach, stimulate the pituitary gland to release growth hormone, which causes somatomedin C production by the liver and other tissues. So it causes you to make more growth hormone, which also is associated with firmness of erection and associated with decreased vascular disease. It's a cheap way of taking growth hormone, but it doesn't work if you mix it with your milkshake or your food because it doesn't act pharmacologically.

So for it to have its effect on the pituitary gland, arginine or glutamine or citrulline, they have to be the only amino acids in the bloodstream. A practical way of doing this is to wake up, and the first thing you take in the morning is not food, and it's not your protein shake, it's the things that work best on an empty stomach. So that might be your SAMe, if you take SAMe, it's your arginine, if you're taking thyroid medication, this is when you take your thyroid with something without amino acids like water or some juice.

Then you wait about 20 minutes, you don't have to wait a long time, 20 minutes before you have your protein meal, or protein shake, or whatever you're doing. So arginine, they say three grams once a day, I would say that's a minimum. Shoot for four grams three times a day on an empty stomach. Now how to get an empty stomach three times a day. What you do is when you think of eating, take the arginine first, just mix a scoop of it. It's interesting, in the pills, hard to get it down, it's a bunch of pills, but you'll see four grams in a scoop is not very much. Mix it in half a glass of water or juice or something, you down it, and wait 10 or 15 minutes before we eat. Arginine is huge.

Now, testosterone. We'll get to, when we talk about hormones in a future episode, it's huge but it's not the subject of today. Omega 3 fatty acids, you'll see here he talks about that, it's proven over and over again it helps circulation. They recommend a gram of omega 3 fatty acids because that's what the American Heart Association talks about.

I'm not as big a fan of folic acid. You can read the paper, take it if you want. Calcium I think it makes people constipated sometimes, and although talk about lowering blood pressure, I think magnesium lowers blood pressure better than calcium, so I'm not as big a fan of those. Vitamin C they say 500 to 1000 mg. I would reduce that to 300 mg, but take your vitamin C at the beginning of a meal, so don't take it with an empty stomach because it's acidic, take your vitamin C and your vitamin E at the beginning of a meal.

So let's go back and look at this again. So arginine and citrulline, arginine's what I would go for. They are going to help with the nitric oxide, promote it, and they also boost growth hormone levels, which he doesn't talk about here. He also mentions another antioxidant that I put here on the page, this. Pycnogenol, it's a very, very, very powerful antioxidant, but you need to take it at least 100 mg per day, and you can take that with food.

Now, what about food? It's interesting to me, by the way this whole, remember you can click there to get to this article and I'll give you a link to this shortly. Food. Food is, it's interesting to me when people talk about, we want to talk about medicines and supplements, which are measured in milligrams. Think about this for a second. Your food is measured in pounds. So if milligrams of supplements can have an effect on your body and your life and your brain and your sexual function, you better believe that food can make a huge, huge difference in your life, and your body, and the way you feel.

Now, I did some research participating with Dr. Atkins. I went to San Francisco when Barry Sears first came out with his own diet. Actually their zone bars, you have to be a certified provider, and be in his training, which was more nutrition by far than I ever learned in medical school, before you could sell the zone bars. I never sold the zone bars when I went out and trained with him, and I've come up with my own ways of combining things.

The problem with the Zone diet is that it's difficult, it takes a lot of time. The low carb diets are not so energizing, so it gets confusing when people talk about food. Counting calories, people don't like that. The bottom line is, after taking care of people for 25 plus years, and I ran a weight loss clinic for about 12 of those years, it's just miserable when people start trying to monitor their food. So there are some principles that I like to teach, and I would recommend two things. I would recommend the Zone book sort of as a way of swinging two bats before you swing one. If you just make a point, and his website's very supportive, make a point of following his diet the best you can for about a week, you'll learn some principles.

For example, it's best to eat about the number of calories that you'll need over the next three hours or so, and then you're sort of titrating the amount of calories, and then if you get the ratios right of protein, carbohydrates, and fat, there's neither a lethargy nor a hunger, both of which make you not at your best function, which is the idea behind the Zone, like a zone an athlete is in.

Now, trying to come up with a cram course in how to teach you both the ideas of fasting, which also does some things with growth hormone, it does some things with your pituitary gland and your brain that make sex better, not during the fast but immediately afterwards, and how to teach the zone, and how to teach low carb, I came up with this crash course that I call the three day fat burn, and it comes with some ideas about exercise. Either way, get one or both of those if you need to think about your nutrition, because if you go back to this article, it is absolutely imperative, if you look at this, look at food. What inhibits, doesn't matter if you're doing your testosterone, your vitamin E and your vitamin C, it does not matter.

You realize this inhibits, so this is lighter fluid for your erection fire, this is water. All these things are putting water on your erections. Smoking, I think if you're a smoker you probably should just consider being a priest, because eventually most guys who smoke, not all, but most guys eventually have some problems with their erections if they're smoking. I don't want to start preaching about smoking. I have some ideas, I have a very high success rate with addiction in general in my practice, and I'll tell you right now, the smoking idea, I'll give you a preview because I have an episode of this coming up, here's a preview.

Freud says you never quit a habit, you only substituted one for the other, but if it's a strong habit like smoking, you have to substitute a bunch of habits for the one habit of smoking, and so I cover that later. High fat, high sugar intake, I think the sugar is by far, in this article you see is 17 years old, but it's still very, very true, and the parts that aren't true I'm telling you, and the high fat has become less important than it was 17 years ago. Now we know you can actually lower cholesterol, and lower and improve blood pressure with high fat diets, as long as they're low sugar.

If you're high fat and high sugar you're just going to gain weight and it's poison. Sugar is the thing that's the poison, and when people say they go on diets where all they do is cut out sugar and white bread, well white bread, bagels, that's just sugar in disguise. It almost instantly turns into sugar, so you might as well just take a spoonful as sugar any time you eat white bread or pizza crust or a bagel. It's literally like eating a candy bar.

The obesity of course, and diabetes, we're not talking about the results here, I'm talking with you about the habits of food, and supplements that will change these other things. Of course diabetes and obesity, because diabetes interfere with erections, because diabetes causes nerve damage, it causes increase atherosclerosis. This is key, and a lot of patients, a lot of people don't think about this. I want you to think about this really, really hard if you're a diabetic person, if you're a person suffering with diabetes, or the trouble of having diabetes. Lowering your blood pressure tied to diabetes, not type I, if you're a type II adult onset, which now sometimes occurs in children, if you suffer with type II diabetes, lowering your blood sugar with a drug is like force feeding your body.

Realize the reason the high blood sugar occurs is your body says, "I've got enough nutrition here." The insulin receptors go down, so the insulin doesn't work anymore, so insulin levels go high. That's why it's called insulin resistance. And blood sugar goes up because the body says, "I don't want this sugar anymore, i already have all the sugar I need."

So it goes high in your bloodstream and you start to urinate the sugar, you start urinating a lot. Now, when you take the insulin, or you take the drug, you're basically force-feeding the body that extra sugar instead of just not eating, or going for a walk and burning the sugar off. The reason I tell you all that is, if you suffer with diabetes I want you to know that, just like being on a blood pressure pill and controlling your blood pressure does not take away the risk of hypertension for increasing your risk of heart disease, having the diagnosis of diabetes and insulin resistance does not take away your risk or problems from that.

As a matter of fact, the research shows that the more tightly you control your blood sugar, more than one study, both as an outpatient and in the hospital, the more tight you control your blood sugar, the more you have an increase in heart disease and stroke. That's a really scary thing, because you're stuck. You need to take the medicines to keep from the problems of hyperglycemia, but yet if you take the medicines then you have problems, too, and that's why, because it's basically force-feeding.

The way to deal with it is increase insulin resistance, and decrease diet at the same time. Increase resistance by exercise, and to do that, if you're on medicines you really need the supervision of a doctor. I don't want to dwell on that too much, but there may be some people dealing with diabetes right now and you need, in my opinion, I hate to say it but unfortunately the nutritionists who were trained by the powers that be that deal with diabetes, in my opinion, often they're not as effective as something, a combination of therapies using something like the zone diet with walking.

The walking or the exercise, again we'll get to that later, but it's not 30 minutes two or three times a week, it's just not adequate. But I have a way of making it easy, so we'll get to that.

Back to his list, he's got ... I think we've covered, and then I have a couple more we'll talk about. So the inhibitors are high fat, although the fat doesn't bother me much, the poisonous sugar, smoking, excessive alcohol. The alcohol changes, here's the thing about alcohol, it changes the way you metabolize sugar. It's not just the sugar in the alcohol, and that's where some of the commercials sort of trick them. They do trick people, because having a low calorie alcoholic drink doesn't make it not change they way you're dealing with sugar. It's effect on the liver has an effect on the way you metabolize sugar that makes you more susceptible to problems with metabolism, even if alcohol itself doesn't have that many calories in it.

Again, I'm not trying to turn you into a priest, but my advice to people is instead of doing drugs like alcohol and caffeine, be a drug. That's what one of the gurus said. Be a personality that is a drug instead of taking drugs.

Again, I don't want to preach at you too much, I'm just telling you we'll get to this later. As a matter of fact, I don't even want you to try to quit the stuff now, I just want you to focus on the things to do, and the things to do we're talking about so far are the arginine, the vitamin E, the not so much calcium, the antioxidants, vitamin C, and folic acid. Now, this nitric oxide promotes cyclic GMP, which causes the erection. The reason Viagra, which is PDE5, the reason it helps the erection is it inhibits the breakdown of the cyclic GMP.

Let's go back to here, we're getting close, there's no reason to make this go, I'm going to open the floor to questions here in a minute. Let's go back to our thing here. So coq10, vitamin E, we talked about, when it came up here ... by the way you can click on these and order from Amazon. You might have another source, but I just shopped Amazon for the best price on what I thought was the best quality. This is 1000 mg and 250 mg, that includes some other things that help.

Okay, so we're into this long enough I think I'll stop here and open it for questions. Before I do, I want to show you, this will be the second in this lesson. We've talked about pumps already. We'll talk about the priapus shot in the next one and really details about hormones and exercise, and then my tips on how to quit smoking. If you want to get the whole thing and you're not subscribed, here's where to subscribe. It's priapusshot.com/peyronies. Even though I'm talking about Peyronie's and researched that literature very carefully, everything I'm talking about here helps erections as well.

Before I open it to everybody, let me see, is there any physicians on the phone who want to add to what we've talked about so far, just raise your hand and I'll unmute your mic, because I know there are some people. Then I'll unmute the mic for anyone else who has questions. So let's see. Elizabeth Owings. So let me unmute your mic, Elizabeth. So Dr. Owings, let me give you a little preview. Dr. Owings has an amazing resume, she's been trained as a pediatrician, a pediatric surgeon, four different residencies, just a brilliant woman, and she's one of our priapus shot providers and she's had some experience that I think she wants to share. Let me see if I can unmute you.

Elizabeth? Dr. Owings?

Elizabeth Owings, MD: Yeah, can you hear me?

Charles Runels, MD: Beautiful, yep. You're up.

Elizabeth Owings, MD: Can you hear me?

Charles Runels, MD: Yes. Can perfectly.

Elizabeth Owings, MD: Okay great. All right, I just wanted to give some hope because I've not worked with a lot of men with Peyronie's disease, but I've worked with a lot of men with erectile dysfunction. I was the chief medical advisor of a supplement manufacturing company for many years, so I know my way around the herbal and nutritional world, the amino acids, the arginine and citrulline. We saw some incredible results with combination products, especially arginine plus citrulline, these two things together. Apparently arginine can be turned interesting nitric oxide, or it can be turned into urea.

One of the things that citrulline does is drive it towards that nitric oxide pathway, and it's just a beautiful thing when you see that work. Just a little piece of hope, I've seen men, diabetic, no erection for 20 years. I'm sorry, someone's trying to call in. No erection for 20 years, successfully complete intercourse after three to six months of combination products like this. That just brings hope because you know that this, it's like this relationship is flowering all over again.

That's the main thing I wanted to share. Blood pressure tends to get better, all sorts of things get better when you're supplementing these things.

Charles Runels, MD: So what does ... two things, first of all three to six months, this is not ... a lot of people think food and nutritional things can be immediate, usually they're not, as she just pointed out. Usually with the change in metabolism there's a change in body, and I know when you change someone's hormones it takes four years for the full effect to take. For example, a woman has a hysterectomy, it's usually three to four years before ... and she's not properly hormonally replaced, so you remove her ovaries, her hormones go crazy. It's usually weight gain for three to four years before she levels off.

Same thing if a man starts taking testosterone, lifting weights, his body will change and he'll plateau three to four years out, so even three to six months is really fast for a metabolic change where you're rebuilding tissue. Obviously these are causing, rebuilding also is causing an accumulation of this nitric oxide, neurotransmitters, nerve. So I heard three to six months. Tell us what dosages you were using when you were in this experience.

Elizabeth Owings, MD: In that particular experience, it was going to be arginine at five to ten grams a day, and this was a liquid product we were working with, although I've had equal results with a powder, this particular one was liquid. I think I'm happier with the powder, we had a lot of diarrhea with the liquid, something about one of the mineral masks or something, but that's okay.

Plus 200 mg of citrulline, 2-400 mg of citrulline. Now, I have seen a product that had some remarkable blood pressure results clinically in a study, that used 1000 mg of citrulline. It was a combination product. Again, just like you said, one of the frustrating things about some of these articles is that they're trying to do one thing at a time, and that's the way you're supposed to do it in your test kitchen, but when we're trying to get someone better from a disease they're not supposed to be able to get better from, I say throw everything at it, do everything. Why are you holding back?

Charles Runels, MD: Yes.

Elizabeth Owings, MD: You have to do your studies in a certain way, but when you're trying to help people get better like we are, I say give the body every chance that it needs, because you don't necessarily know what tests to order to find out what they're deficient in sometimes. You just know that if we do this combination of things they're going to get better.

Anyway, most recent one had I think a gram and a half of arginine and a gram of citruline, and some other things like a micronized cayenne. They didn't have hawthorn in this one, but just a couple other things in there, red yeast rice extract. Several things put together and you're really going to see good results with that.

There are lots of things out there. You can get a good testimonial from anybody, I'm just saying there's hope. If you've been told there's no hope, and you've been impotent for 10 or 20 years and you just live with it, I'm telling you there's hope.

Charles Runels, MD: Beautiful. Let's see, so stay on the line. We may have someone else that you can help me with. Someone wrote in and said, "I've noticed I have back pain from taking one to two grams of arginine. Do I just need more water?"

I've heard the diarrhea and nausea. Glutamine has a similar effect of arginine, so that's an idea, but you have any ideas on that, Dr. Owings, as far as the back pain? That's a new one for me.

Elizabeth Owings: I don't think I've run into that before, although I'll tell you where the conversion is, is in the liver and the kidneys. I don't know, it may be one of those things where you want to spread the dose out and see if the back pain goes away. I'm not as strict a disciplinarian as I used to be, nothing happens twice a day, or heaven forbid three times a day in my house. I have to take my arginine first thing in the morning or the last thing before I go to bed. Two scoops go in my big bottle of water, I shake it up and down it while I'm doing my workout or whatever.

This may be a person that wants, instead of that approach, spread it out two or three times a day and see if that doesn't improve it. I wish I knew where the back pain was, if it was central or bilateral, or ...

Charles Runels MD: I'll go along with what you said earlier, too, about powder versus liquid. I just think the powder's easier to carry around obviously than the liquid, as far as the practicality of taking something two or three times a day. The only way I've found to do that is to keep it at home, wherever I eat breakfast, and at the office or in my backpack when I was an ER doctor, so that whenever I ate lunch it would be there and it would be the thing I did right before I ate the lunch.

But you're right, unless you have something to trigger it, or it's there with you all the time, then it's almost impossible to do something three or four times a day. Let's see if I see any other hands up. Let's see.

Annette has her hand up, we'll see if I can ... can you type the question in, Annette? I'm trying to unmute you.

Someone is asking, would you give her a combination of items again, Dr. Owings?

Elizabeth Owings, MD: Yeah, sure.

Charles Runels, MD: So your ultimate combination.

Elizabeth Owings, MD: Would include arginine, citrulline for sure, a combination of antioxidants, especially the ones that you cannot store, so your B and C, your B combination and C, vitamin D, it's been shown to be a shepherd of the gene pool, we only have 20,000 genes, and vitamin D may influence up to 10% of those, and it appears to be favorable in every case. Down regulate cancer genes, and up regulate heart health things.

I once downloaded a cardiology article that had like 150 references of the impact of vitamin D on the cardiovascular system and cardiovascular health and heart disease. So definitely at least 2000 IUs of vitamin D and 5000 is perfectly okay. There's never been a toxicity associated with even taking 10,000 units of vitamin D a day. Don't let them scare you.

Those are going to be the main things. I love coq10, and now it's less expensive. I'm not committed to whether the water soluble or fat soluble is better. I think it just depends. People have had their gallbladders out, there's all sorts of factors that may play in there that are hard to determine, so I think the jury's out on that one.

I'm still a hawthorn fan, it doesn't take a lot of the hawthorn berry to get some benefit. Red yeast rice, I mean they'll still hold the shipment offshore for a little while because somebody's trying to say it's a drug because it's the same active ingredient that's in some of your statin medications. The reason your statins are dangerous is that they don't have coq10. They knew that statins cause liver and muscle damage 20 years ago, and they thought about putting coq10 with it because it seemed to prevent that, and they just decided not to. I guess it was an expense.

So definitely if you're going to take the statin or you're going to take something with red yeast rice, you better make sure you got your coq10. Probably even 30 mg is enough to offset some of the badness of it, but like you said up to 300 mg if you want the most positive effect.

That's a long list. I don't know if any one product has all of those things, but those are the kind of things that I look at when I'm looking at a cardiovascular product.

Charles Runels, MD: Let me add to some of the things you said. The vitamin D is not in this article, because as you know some of that research is more recent, and I just want to second that. Somewhere around 10,000 per day. The other thing that's not really talked about very much anymore, there used to be a prescription version of yohimbe. It's really hard to come by a pharmaceutical grade yohimbe, and if you don't take the right amount, if it's sort of low grade, it can make you have chills and headaches. But a 5 mg yohimbe, a pharmaceutical grade, would cure erectile dysfunction in 25% of men, and it's one of the only things, only supplements out there that actually increases libido.

Now, I can also make people irritable, and there's talk about it can raise blood pressure, but if you do the other things that we talk about with the walking, I never saw the blood pressure problem, but if you use yohimbe you have to think about blood pressure headaches and irritability. But a pharmaceutical grade yohimbe will treat, before we had Viagra that's what we had, and 25% of men with erectile dysfunction would be cured.

Coleus root is another one. In rat studies, they castrated rats. C-O-L-E-U-S. They castrated rats and gave them, one group got testosterone, the other group got coleus, and coleus root caused them to start to have sex again as much as the testosterone. Let me add one other thing that I thought was interesting in this article, that the men who took a combination of arginine and pycnogenol also increased their semen volume, which you know some guys want to do that just sort of as a party trick sort of thing, it's just fun to have lots of semen volume, but I think the semen volume contributes to libido, just like when you need to empty your bladder when it's full, when your prostate's full of fluid, of course that's where most of the volume comes from is the prostate gland, when it's full of fluid there's I think more urge to have sex. I think that's part of the reason our O-Shot® works is it causes women to collect fluid in their Skene's glands.

Let me see I we have any more questions. I think that's ... here we go. I guess that's maybe it. We have other doctors on the call. Dr. Posey's one of our doctors, and others here. Anybody else have anything they want to say? If not I'll just shut it down, no reason to make it go on, but that's sort of our secret formula, and sometime in the next week or so we'll cover the next part of this idea, and we'll talk more about the priapus shot, then hormones, and then my ideas about walking and things such as that.

I'll put this recording, I'm typing in here where it will be, it will be at priapusshot.com/food. So that's where it will be, by in the morning we'll have the recording there. I was honored you guys came and I hope you find this helpful. Thank you very much.

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