Category: Priapus Shot®

  • New Research Shows Alternative Protocol to be Inferior to the P-Shot® (Priapus Shot®) Procedure

    New Research Shows Alternative Protocol to be Inferior to the P-Shot® (Priapus Shot®) Procedure

    Researchers (Masterson, 2023) recently used a protocol (that differs from the P-Shot® procedure) and measured the effect on erectile function of injections of the penis with platelet-rich plasma (PRP).

    Their protocol was less effective than what previous studies have shown. You can read the article here<–

    Before reviewing their research and their deviations from the P-Shot® protocol, consider what the P-Shot® is: The P-Shot® (Priapus Shot®) is a service mark that names a procedure that requires training in the standard protocol and an agreement to follow the protocol that has been used (with improvements) for the past 13 years.

    The ways Masterson, et al changed the procedure (from that of the P-Shot® procedure) for their study include at least all of the following:

    1. They used a different injection technique than what is used with the P-Shot® procedure; their technique limited the exposure of the penis to less than 1/2 of the tissue treated by the P-Shot® procedure.
    2. They used a centrifuge that is not on the recommended list of devices approved by the FDA for the preparation of PRP for injection back into the body. Their centrifuge also differs from what was used in other studies that showed benefits.  The centrifuge used can have dramatic effects on not only the number of platelets but also the number of white blood cells and red blood cells in the sample–all of which is important in regard to results.
    3. They injected 1/2 the volume of PRP usually injected. They injected a total of 5 cc instead of 10 or more cc’s. So not only did their injection technique limit the distribution, but the volume injected limited the treatment area and the number of platelets.
    4. They did not activate the PRP with Calcium Chloride (or with any agent at all). Without activation, the PRP is more prone to washout, and the growth factors in their 1/2 dose are further limited by being more shortlived than with the P-Shot® procedure. There is a huge difference between the growth factor spectrum and the duration of effect when the activation is modified.
      PRP can be modified by varying leukocyte count, platelet concentration, method of activation, and red blood cell count. (Sheean, 2021)

    Other points about the study:

    1. They calculated sample size based on the assumption that the placebo group would have a 15% rate of attaining MCID, not the observed 50%; so the study was grossly underpowered and conclusions invalid.  Still, we can look at more…


    2. Even though they saw less response (with their altered protocol) than what has been shown in other studies, they still saw improvement in erectile function after injection of PRP; the change was just not significantly greater than saline. Both showed improvement.


    3. Also, what they called a placebo, saline, has been shown to have regenerative properties when injected directly into tissue. When injected iv to compare with a drug, saline is an adequate placebo. When injected into tissue, it has been shown to help improve joint disease and help with leishmaniasis, granuloma annulare, and atrophic acne scars–saline, when injected into soft tissue, is not a placebo.

    “Even when used as a control, saline exerts some therapeutic action in different dermatological indications, including warts, acne scars, and rejuvenation.” (El-Amawy, 2020)


    4. In previous double-blind, placebo studies of PRP for ED, PDE5is were discontinued. In one study, the placebo response (still using saline) was only 15%. Masterson, et al allowed participants to continue their Viagra drugs, which could account for the higher placebo response. The high placebo response also attenuates the power of the study.


    5. The study is also compromised mathematically by a 15% dropout rate in an already small sample size.


    6. In their introduction, Masterson et. al writes the following: “Even without supporting data, numerous clinics in the largest metropolitan areas of the United States are charging patients for PRP treatments for ED.”

    Yet, there IS “supporting data.” Previous studies indeed have shown that PRP does help with ED and with Peyronie’s disease One of those studies was even done by Dr. Ronald Virag, the pioneer in urology who came up with the idea that became “tri-mix” injections for erection and changed urology forever.

    The near disappearance of plaque seen in Peyronie’s disease after injection with PRP (Virag, 2017)

    The authors failed to recognize all of those studies by stating there is “no supporting data.”


    7. They do, later in their discussion, contradict/correct their own statement (“no supporting data”) by making reference to two of many articles that support the P-Shot® procedure and the injection of PRP for ED.

    Then, they reference an article in JAMA that later required a printed correction; but make no reference to the correction, which undermines their point.


    8. Also, the authors fail to point out, in their worries about the money being charged, that the P-Shot® procedure has fewer side effects than Viagra (which has been shown to cause blindness in some) and its cousin drugs and that the cost of a P-Shot® can be less than pharmaceutical alternatives (over time), much less invasive and less expensive than a penile implant, and that P-Shot® providers have agreed to refund the money of anyone not helped by the procedure.

    The P-Shot® in no way makes these alternative treatments not useful and needed. But, the P-Shot® should be part of the tools available for treatment, and a man should be able to try the P-Shot® before proceeding to implant.


    9. Moreover, the Priapus Shot® procedure is NOT just to give a shot. The procedure includes an evaluation to see if the shot is appropriate. There must be phlebotomy (usually another skilled employee’s time and expense) and processing of blood using FDA kits approved for processing blood for autologous reinjection (not cheap). The cost to the patient helps covers these expenses.


    10. Other studies have shown a greater improvement in erectile function than what was seen by these authors. So, we are grateful for their contribution–showing that a different protocol works less well. Further studies are needed to look at the variables regarding the preparation of the PRP, activation, and injection technique to understand further why their protocol was less effective and how current protocols can be improved.

    Some of the supporting data for PRP for the treatment of ED.

    11. Also, further studies are needed regarding combination therapies. For example, one prospective, randomized, controlled study showed that PRP greatly improved the results seen with shock waves for erectile dysfunction.


    In conclusion, Masterson et al demonstrated (in this underpowered study using a placebo that is not a placebo) that injecting 1/2 the volume of the P-Shot® procedure using their alternative technique of injecting and not activating the PRP with CaCl is possibly less effective than what has been shown in other studies. That is valuable to know, and we are grateful for their study.


    To find the nearest P-Shot® (Priapus Shot® provider)<–

    To apply for training for the P-Shot® procedure<–

    Charles Runels, MD

    Charles Runels, MD
    Cellular Medicine Association
    1-888-920-5311
    DrRunels@Runels.com

    References

    References Regarding the Benefits of the P-Shot® Procedure for ED

    Bosma-Den Boer, Margarethe M., Marie Louise Van Wetten, and Leo Pruimboom. “Chronic Inflammatory Diseases Are Stimulated by Current Lifestyle: How Diet, Stress Levels and Medication Prevent Our Body from Recovering.” Nutrition and Metabolism 9 (2012). https://doi.org/10.1186/1743-7075-9-32.

     

    Casabona, Francesco, Ilaria Gambelli, Federica Casabona, Pierluigi Santi, Gregorio Santori, and Ilaria Baldelli. “Autologous Platelet-Rich Plasma (PRP) in Chronic Penile Lichen Sclerosus: The Impact on Tissue Repair and Patient Quality of Life.” International Urology and Nephrology 49, no. 4 (April 2017): 573–80. https://doi.org/10.1007/s11255-017-1523-0.

     

    Chung. “A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction.” Medical Sciences 7, no. 9 (August 29, 2019): 91. https://doi.org/10.3390/medsci7090091.

     

    Chung, Eric. “Medical Sciences A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction,” 2019, 1–11.

     

    Everts, Peter, Kentaro Onishi, Prathap Jayaram, José Fábio Lana, and Kenneth Mautner. “Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020.” International Journal of Molecular Sciences 21, no. 20 (October 21, 2020): 7794. https://doi.org/10.3390/ijms21207794.

     

    Garcia, MM, TM Fandel, G Lin, AW Shindel, L Banie, CS Lin, and TF Lue. “Treatment of Erectile Dysfunction in the Obese Type 2 Diabetic ZDF Rat with Adipose Tissue-Derived Stem Cells,” 2010, 14.

     

    Israeli, Joseph M., Soum D. Lokeshwar, Iakov V. Efimenko, Thomas A. Masterson, and Ranjith Ramasamy. “The Potential of Platelet-Rich Plasma Injections and Stem Cell Therapy for Penile Rejuvenation.” International Journal of Impotence Research, November 6, 2021, 1–8. https://doi.org/10.1038/s41443-021-00482-z.

     

    Kumar, C.S. “265 Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump for Penile Enlargement.” The Journal of Sexual Medicine 14, no. 1 (January 2017): S78. https://doi.org/10.1016/j.jsxm.2016.11.174.

     

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

     

    Liu, Ming-Che, Meng-Lin Chang, Ya-Chun Wang, Wei-Hung Chen, Chien-Chih Wu, and Shauh-Der Yeh. “Revisiting the Regenerative Therapeutic Advances Towards Erectile Dysfunction.” Cells 9, no. 5 (May 19, 2020): 1250. https://doi.org/10.3390/cells9051250.

     

    Matz, Ethan L, Amy M Pearlman, and Ryan P Terlecki. “Safety and Feasibility of Platelet Rich Fibrin Matrix Injections for Treatment of Common Urologic Conditions.” Investigative and Clinical Urology 59, no. 1 (January 2018): 61–65. https://doi.org/10.4111/icu.2018.59.1.61.

     

    Matz, Ethan L., Kyle Scarberry, and Ryan Terlecki. “Platelet-Rich Plasma and Cellular Therapies for Sexual Medicine and Beyond.” Sexual Medicine Reviews 10, no. 1 (January 2022): 174–79. https://doi.org/10.1016/j.sxmr.2020.07.001.

     

    Poulios, Evangelos, Ioannis Mykoniatis, Nikolaos Pyrgidis, Filimon Zilotis, Paraskevi Kapoteli, Dimitrios Kotsiris, Dimitrios Kalyvianakis, and Dimitrios Hatzichristou. “Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.” Journal of Sexual Medicine 18, no. 5 (May 1, 2021): 926–35. https://doi.org/10.1016/j.jsxm.2021.03.008.

     

    Raheem, Amr Abdel, Giulio Garaffa, Tarek Abdel Raheem, Michelle Dixon, Amanda Kayes, Nim Christopher, and David Ralph. “The Role of Vacuum Pump Therapy to Mechanically Straighten the Penis in Peyronie’s Disease.” BJU International 106, no. 8 (2010): 1178–80. https://doi.org/10.1111/j.1464-410X.2010.09365.x.

     

    Ruffo, A., M. Franco, E. Illiano, and N. Stanojevic. “Effectiveness and Safety of Platelet Rich Plasma (PrP) Cavernosal Injections plus External Shock Wave Treatment for Penile Erectile Dysfunction: First Results from a Prospective, Randomized, Controlled, Interventional Study.” European Urology Supplements 18, no. 1 (March 2019): e1622–23. https://doi.org/10.1016/S1569-9056(19)31175-3.

     

    Schirmann, A., E. Boutin, A. Faix, and R. Yiou. “Pilot Study of Intra-Cavernous Injections of Platelet-Rich Plasma (P-Shot®) in the Treatment of Vascular Erectile Dysfunction.” Progrès En Urologie, June 2022, S1166708722001300. https://doi.org/10.1016/j.purol.2022.05.002.

     

    Shaher, Hussein, Abdallah Fathi, Salah Elbashir, Shabieb A. Abdelbaki, and Tarek Soliman. “Is Platelet Rich Plasma Safe And Effective In Treatment Of Erectile Dysfunction? Randomized Controlled Study.” Urology, February 2023, S0090429523000742. https://doi.org/10.1016/j.urology.2023.01.028.

     

    Siroky, Mike B., and Kazem M. Azadzoi. “Vasculogenic Erectile Dysfunction: Newer Therapeutic Strategies.” Journal of Urology 170, no. 2S (August 2003). https://doi.org/10.1097/01.ju.0000075361.35942.17.

     

    Towe, Maxwell, Akhil Peta, Russell G. Saltzman, Navin Balaji, Kevin Chu, and Ranjith Ramasamy. “The Use of Combination Regenerative Therapies for Erectile Dysfunction: Rationale and Current Status.” International Journal of Impotence Research, July 12, 2021, 1–4. https://doi.org/10.1038/s41443-021-00456-1.
    Masterson, Thomas A., Manuel Molina, Braian Ledesma, Isaac Zucker, Russell Saltzman, Emad Ibrahim, Sunwoo Han, Isildinha M. Reis, and Ranjith Ramasamy. “Platelet-Rich Plasma for the Treatment of Erectile Dysfunction: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.” Journal of Urology, April 30, 2023, 10.1097/JU.0000000000003481. https://doi.org/10.1097/JU.0000000000003481.

    References Regarding P-Shot® Procedure for Peyronie’s Disease

    Culha, Mehmet Gokhan, Erkan Erkan, Tugce Cay, and Uğur Yücetaş. “The Effect of Platelet-Rich Plasma on Peyronie’s Disease in Rat Model.” Urologia Internationalis 102, no. 2 (2019): 218–23. https://doi.org/10.1159/000492755.

     

    Levine, Laurence A. “Peyronie’s Disease: Contemporary Review of Non-Surgical Treatment.” Translational Andrology and Urology 2, no. 1 (2013): 39–44. https://doi.org/10.3978/j.issn.2223-4683.2013.01.01.

     

    Raheem, Amr Abdel, Giulio Garaffa, Tarek Abdel Raheem, Michelle Dixon, Amanda Kayes, Nim Christopher, and David Ralph. “The Role of Vacuum Pump Therapy to Mechanically Straighten the Penis in Peyronie’s Disease.” BJU International 106, no. 8 (2010): 1178–80. https://doi.org/10.1111/j.1464-410X.2010.09365.x.

     

    Virag, Ronald, Hélène Sussman, Sandrine Lambion, and Valérie de Fourmestraux. “Evaluation of the Benefit of Using a Combination of Autologous Platelet Rich-Plasma and Hyaluronic Acid for the Treatment of Peyronie’s Disease.” Sexual Health Issues 1, no. 1 (2017). https://doi.org/10.15761/SHI.1000102.

     

    References Regarding Saline is Not a Placebo

    Asghar, Aneela, Zahid Tahir, Aisha Ghias, Usma Iftikhar, and Tahir Jameel Ahmad. “Efficacy and Safety of Intralesional Normal Saline in Atrophic Acne Scars.” Annals of King Edward Medical University 25, no. 2 (June 24, 2019). https://doi.org/10.21649/akemu.v25i2.2867.

     

    Bagherani, Nooshin, and Bruce R Smoller. “Introduction of a Novel Therapeutic Option for Atrophic Acne Scars: Saline Injection Therapy.” Global Dermatology 2, no. 6 (2016). https://doi.org/10.15761/GOD.1000159.

     

    Bokey, E. L., J. P. Keating, and P. Zelas. “HYDRODISSECTION: AN EASY WAY TO DISSECT ANATOMICAL PLANES AND COMPLEX ADHESIONS.” ANZ Journal of Surgery 67, no. 9 (September 1997): 643–44. https://doi.org/10.1111/j.1445-2197.1997.tb04616.x.

     

    Cass, Shane P. “Ultrasound-Guided Nerve Hydrodissection: What Is It? A Review of the Literature” 15, no. 1 (2016): 3.

     

    “Clinical Benefit of Intra-Articular Saline as a Comparator in Clinical Trials of Knee Osteoarthritis Treatments_ A Systematic Review and Meta-Analysis of Randomized Trials | Elsevier Enhanced Reader.” Accessed April 6, 2022. https://doi.org/10.1016/j.semarthrit.2016.04.003.

     

    El-Amawy, Heba Saed, and Sameh Magdy Sarsik. “Saline in Dermatology: A Literature Review.” Journal of Cosmetic Dermatology 20, no. 7 (2021): 2040–51. https://doi.org/10.1111/jocd.13813.

     

    Popp, Lothar W. “Improvement in Endoscopic Hernioplasty: Transcutaneous Aquadissection of the Musculofascial Defect and Preperitoneal Endoscopic Patch Repair.” Journal of Laparoendoscopic Surgery 1, no. 2 (January 1991): 83–90. https://doi.org/10.1089/lps.1991.1.83.

     

    Saltzman, Bryan M., Timothy Leroux, Maximilian A. Meyer, Bryce A. Basques, Jaskarndip Chahal, Bernard R. Bach, Adam B. Yanke, and Brian J. Cole. “The Therapeutic Effect of Intra-Articular Normal Saline Injections for Knee Osteoarthritis: A Meta-Analysis of Evidence Level 1 Studies.” The American Journal of Sports Medicine 45, no. 11 (September 1, 2017): 2647–53. https://doi.org/10.1177/0363546516680607.

     

    Searle, Tamara, Firas Al-Niaimi, and Faisal R. Ali. “Saline in Dermatologic Surgery.” Journal of Cosmetic Dermatology 20, no. 4 (2021): 1346–47. https://doi.org/10.1111/jocd.13996.

     

    Sharma, ReenaK, Mudita Gupta, and Ritu Rani. “Delineating Injectable Triamcinolone-Induced Cutaneous Atrophy and Therapeutic Options in 24 Patients—A Retrospective Study.” Indian Dermatology Online Journal 13, no. 2 (2022): 199. https://doi.org/10.4103/idoj.idoj_483_21.

     

    References Regarding the Activation of PRP

    Hamilton, Bruce, Johannes L. Tol, Wade Knez, and Hakim Chalabi. “Exercise and the Platelet Activator Calcium Chloride Both Influence the Growth Factor Content of Platelet-Rich Plasma (PRP): Overlooked Biochemical Factors That Could Influence PRP Treatment.” British Journal of Sports Medicine 49, no. 14 (July 1, 2015): 957–60. https://doi.org/10.1136/bjsports-2012-091916.

     

    Kao, David S., Stephanie W. Zhang, and Alexander R. Vap. “A Systematic Review on the Effect of Common Medications on Platelet Count and Function: Which Medications Should Be Stopped Before Getting a Platelet-Rich Plasma Injection?” Orthopaedic Journal of Sports Medicine 10, no. 4 (April 1, 2022): 232596712210888. https://doi.org/10.1177/23259671221088820.

     

    Sheean, Andrew J., Adam W. Anz, and James P. Bradley. “Platelet-Rich Plasma: Fundamentals and Clinical Applications.” Arthroscopy: The Journal of Arthroscopic & Related Surgery 37, no. 9 (September 2021): 2732–34. https://doi.org/10.1016/j.arthro.2021.07.003.

     

    Smith, Oliver J., Selim Talaat, Taj Tomouk, Gavin Jell, and Ash Mosahebi. “An Evaluation of the Effect of Activation Methods on the Release of Growth Factors from Platelet-Rich Plasma.” Plastic and Reconstructive Surgery 149, no. 2 (February 2022): 404–11. https://doi.org/10.1097/PRS.0000000000008772.

     

    Smith, Stephanie A., Richard J. Travers, and James H. Morrissey. “How It All Starts: Initiation of the Clotting Cascade.” Critical Reviews in Biochemistry and Molecular Biology 50, no. 4 (July 4, 2015): 326–36. https://doi.org/10.3109/10409238.2015.1050550.

     

    Toyoda, Toshihisa, Kazushige Isobe, Tetsuhiro Tsujino, Yasuo Koyata, Fumitaka Ohyagi, Taisuke Watanabe, Masayuki Nakamura, et al. “Direct Activation of Platelets by Addition of CaCl2 Leads Coagulation of Platelet-Rich Plasma.” International Journal of Implant Dentistry 4 (August 1, 2018): 23. https://doi.org/10.1186/s40729-018-0134-6.

     

    Ulasli, Alper Murat, Gokhan Tuna Ozturk, Bagdagul Cakir, Gulsemin Erturk Celik, and Fatih Bakir. “The Effect of the Anticoagulant on the Cellular Composition and Growth Factor Content of Platelet-Rich Plasma.” Cell and Tissue Banking, August 28, 2021. https://doi.org/10.1007/s10561-021-09952-6.
  • Priapus Shot® for Improved Sexual Function. Vegas 2018

    International Society for Cosmetogynecology<–

    Cellular Medicine Association<–

    Transcript

    Dr. Marco Pelosi III: Our next speaker is probably best described as the Michael Jordan of platelet rich plasma, Dr. Charles Runels from Alabama, that pioneered the O-Shot® [Orgasm Shot®], the Vampire [Face]lift®, the P-Shot® [Priapus Shot®], and he’s taken all the abuse and he’s given the world some very, very useful procedures for everyone. He’s going to talk about the studies he did and the studies done in platelet rich plasma in regards to sexual function. Dr. Runels, it’s a pleasure to have you here.

    Dr. Runels: Thank you for having me.

    I’m going to go through a whirlwind look at research that’s been done where people have used PRP to help with sex. Much of the research has been done by the people in our group, and I’ve described many of them in this room who have done this research. It’s a for-profit organization, but we pay for research, we pay for education, we pay for marketing for our providers. Just to echo what you just heard, sex is much more than about just having fun. Rainer Maria Rilke said it’s just so correlated to the creative experience that it’s affecting how we do our work, how you do your presentation, and how – of course – relationships and families.

    I want to echo that sentiment, and remind us that back in 1980, if you look in ‘Urology’ – this was ‘Urology’ 1980 – the most common cause for erectile dysfunction was thought to be 85% psychogenic. Here’s a quote from ‘Urology’ where urologists were encouraged to become counselors, because most of erectile dysfunction was thought to be psychogenic. Of course, I’m echoing the penis stuff because if you take a penis and shrink it and unzip it, that becomes a clitoris. I’m thinking most of the research will eventually apply to that. Certainly, our attitude is applying because we’re back in the … We’re not, I’m preaching to the choir, but many of our colleagues are back in the 1980’s and saying the main thing we have for sexuality for women is counseling.

    My thinking that perhaps, as you guys do, some of the pathology that applies to the penis may apply to the clitoris, and maybe some of these women are suffering from actual genital histopathology, not just psychogenic problems. We have this one FDA approved drug now for female sexual dysfunction that’s a psych drug, flibanserin. It’s a useful drug, but obviously, we need much more and maybe we should think in terms of systems, like we do for the rest of the body.

    Platelet Rich Plasma.

    Obviously, this is not a new idea. This is from, this month, over 9,000 papers indexed in PubMed about platelet rich plasma. Our orthopedic colleagues, our dentist, our facial plastic surgeons have worked with this, and all we have to do is take their ideas and then hopefully people in this room will extend what I’m about to show you and just take those ideas and adapt them to the genital space. Here’s some of the growth factors we know about. There are many more. They have these effects. These are good things for the genitalia. Down-regulating autoimmune response, proliferation of fibroblasts, new angiogenesis, the adipocytes enlarge and multiply – think labia majora, collagen production, neurogenesis and maybe some glandular function.

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    There’s never, in all those 9,000 papers, I still cannot find one serious side effect. No granulomas, no serious infection. PRP is what your body makes to heal when you do your surgeries and help prevent infection. Obviously, there are always certain things that can happen, bruising and such, but if you have a serious life-threatening complication from PRP, you will have the first recorded in all of that 9,000 plus papers. That’s a nice thing.

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    We have commercially available methods for preparing it, within 5 or 10 minutes of the bedside, and the devices are FDA approved. So you guys don’t get confused, obviously the FDA does not approve your procedures. That’s a doctor business. They don’t approve blood that belongs to you, just like your spit and your saliva and your skin. They tried, at one time, to control eggs and the gynecologists said, “Hell no.” So they don’t control eggs and they don’t control blood, but you should use an FDA approved device if you do this [approved for preparation of PRP to go back into the body].

    Autoimmune Disease

    Here’s some of the ideas about down-regulating autoimmune response. We have split-scalp studies showing that PRP helps alopecia areata better than triamcinolone. More hair growth that comes in thicker. Here’s rat studies looking at rheumatoid arthritis. What do we have in the genital space? We have lichens sclerosus. We did some before and after pictures where you use stem cells mixed with PRP, and before and after pictures show improvement. Of course, that’s two variables because you have stem cells and you have the PRP.

    We took the same idea and just used PRP. Andrew Goldstein worked with me on this, and we had two blinded dermatopathologists. The protocol was biopsy, PRP, wait six weeks later, another PRP injection, and then six weeks after that, another biopsy. Two blinded dermatopathologists out of George Washington University did not know the before or the after. We showed statistical improvement in both the histology and symptomatology. Here’s our histology. You can see obviously, that’s the same magnification and we’re showing decreased hyperkeratosis. That’s obviously healthier tissue. A layperson could tell that’s better. Of course if you look at the gross pictures, lady on the left as you guys know, she has pain wearing her blue jeans. The lady on the right is back to making love to her husband. They’ve invited me into their close Facebook groups and I saw a post a few months ago. Quote says, “I was sitting next to my husband, whom I love, last night. I was afraid to hold his hand because I was afraid he would become aroused and I’m bleeding and hurting today.” That’s what you guys are helping.

    We published that in ‘Lower Genital Tract Disease’. We extended it because it worked. We published this past January in the journal of the American Academy of Dermatology. You have some science to go do this now.

    One of our providers, Kathleen Posey, who’s a gynecologist out of New Orleans, took this idea and then she said, “Let’s do some dissection in the office”, and she presented this in Argentina, published it in the same journal ‘Lower Genital Tract Disease’. Here’s one of her patients, where you can introduce [inaudible 00:06:44]. It had been 12 years since she had had sexual intercourse, penis and vagina intercourse, with her loving husband … 12 years. She was being followed by a dermatologist on high dose clobetasol. Kathleen dissected it out in the office and then injected PRP … 8 weeks later, she’s having comfortable sex with her husband. She’s now 3 years out. She’s had to be treated with PRP, not repeat surgery … PRP now, 2 other times a year apart to maintain that result. She now has a series of 60 or so patients that she’s now going to publish with similar results, where she’s dissecting out – as you guys know how to do – treating the [inaudible 00:07:27], but then following that with PRP injections to help the healing and decease the autoimmune response.

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    That same doctor, Casabona, repeated his study with lichen sclerosus in men [BXO], and showed with just PRP alone … This study of 45 men with repeat treatments … It is cumulative, 2 to 10 treatments, the same thing. All of them stopped their steroids. None of them started back. Only one went on to have circumcision.

    Peyronie’s

    Peyronie’s disease, another autoimmune disease … This came out this month out of Wake Forest, where they took men and they followed their results with Peyronie’s disease. Not only did their Peyronie’s improve statistically, but they also improved their erectile dysfunction by 5 on that scale of 5 to 25 that the urologists use. For some reason, thankfully, they threw in one woman just for good measure, and showed that it helped her incontinence. They just tucked that in as an aftermath.

    Ronald Virag, as you guys know as the legendary vascular surgeon who was first to present the idea of intracavernosal injections for erectile dysfunction, out of Paris. His big thing now is PRP for Peyronie’s. He just published a study where he showed that this is comparing PRP with Xiapex, which is a $50,000 series of injections, FDA approved version of collagenase. He showed that PRP works better with few side effects. There’s a risk of about 1 in 30, that actually go from a bent pencil to a fractured pencil and a limp noodle. You don’t see that with PRP. You see the side effect is the erectile function improves. He showed the same thing, actually, in his studies that erectile dysfunction improves by an average of about 7 on that 5 to 25 point scale.

    Wound Healing/Scar Resolution

    Let’s think about the [inaudible 00:09:29] literature. Look at this, there’s so much of this out there. This is looking at post-operative adhesions, lots of studies looking at scarring with microneedling and PRP. This is a split-face study comparing PRP with microneedling verus PRP … Excuse me, microneedling with saline or Vitamin C serum and split-faced studies in PRP wins. Dr. Sclafani did some studies in the cosmetic space looking at increased collagen production and fibroblast activity, and never a neoplasia documented. People worry about that. This is not indiscriminate blindness blind growth. You don’t worry about carcinogenesis when you do surgery and it’s the same PRP that’s causing healing. There’s actually some helpful immune processes that go on, that you could argue actually might help prevent cancer. I’m not going to make that argument but it might need to be made one day.

    If you look further, here’s a wound healing study looking at reepithelialized exposed bone and tendon of the foot and ankle. When I took that and applied, this is a hypertrophic scar that was a year old from cortisone, and then using PRP and Juvederm or HA filler, this is a few days later, a month later, and that’s a year later. Now, take that and think, “How could I use that in the genitourinary space?” Doing that anecdotally, we have many of the members of our group are seeing help with episiotomy scars or dyspareunia, pelvic foreplay instead of injecting that pelvic floor tenderness with triamcinolone. Physiatrist for the past ten years has been using PRP, your sports medicine doctors. Now, when you palpate it, consider injecting with PRP instead. Dyspareunia from mesh and that unknown dyspareunia, we’re seeing this is where we need you guys to help extend the research. The science is there that it should help and it seems to be helping. Not 100%, but about 80% in people with dyspareunia.

    Mesh Pain

    Here is a look at a gentleman who did … He took the mesh out and then he patched the hole with a gel form of PRP and showed benefit. We’re finding anecdotally – no one’s done this study yet, here’s another one for you to pick up … I’m giving you low hanging fruit. We’re seeing anecdotally that if you inject in the distribution of the pudendal nerve, which seems to be inflamed in some women with mesh pain, that their pain will frequently go from 9 out of 10 down to 1 or 2 out of 10, without even taking the mesh out. Just another place where we need some research done.

    Interstitial Cystitis

    Here, we have rat studies looking at inflammation. Let’s think about this one. Here’s a rat study where they modeled cystitis and we are seeing in chronic interstitial cystitis without even infiltrating the bladder, just infiltrating in the periurethral space, some of our women are getting better. I’ve had two separate urologists call me and say, “Charles, I can’t believe it. I was doing this and expecting not this to happen. I have these patients now who have had chronic interstitial cystitis pain for years, and it’s gone.” Not 1005 but finding out who’s going to respond and who’s not and why, there’s a lot of variables that need to be thought about that you guys will hopefully do the research.

    Penis Growth

    Here’s a study that came out in the ‘Journal of Sexual Medicine’, where a guy took … the [inaudible 00:12:51] men who have an erection of 3 inches or less and then he treated them with PRP, combined with a pump, and showed that if you repeated it every time you did it, it grew by about 7 millimeters. I’ve always thought if I could give you a guarantee half an inch to an inch with anything, I’d get my picture on a postage stamp. I don’t have that yet, but I can tell you that we’re seeing about 60% of the time we do this procedure, men will see some sort of growth.

    If you look at the neovascular space, there was a study out of Southern California that was published in the ‘Journal of Sexual Medicine’ where they transferred adipocyte stem cells to the penis of diabetic rats. They showed new endothelial cell growth and increased nitric oxide activity in the dorsal nerve. Would that be helpful in the clitoris? Probably, but the interesting thing is the adipocyte-derived stem cells were attacked and they died. The postulate was the improvement was from the growth factors.

    Penile Rehabilitation and Erectile Dysfunction

    I have seen what [inaudible 00:13:52] have seen in that when you inject this in the penis, erectile function goes up on the average of about 5 to 7 per injection. Think about nerve repair. We have rat studies modeling prostrate surgery, showing that the nerves improved with PRP and so we have, again, another clear place where we need studies if you add this now to the usual protocol for rehabilitating the penis post-prostate surgery … would you see benefit? We have seen that in some of our patients who are a year or two out who failed the rehabilitation part of that. Would that help your patients who have, say, numbness and decreased function from riding their bikes too much, or trauma? I don’t know, but it’s worth thinking about and publishing research about.

    Next Workshops With Live Models<–

    In thinking about where to put this, where we do our O-Shot, when we do PRP to the anterior vaginal wall, we’re putting it as distal from the bladder as possible. We found that it works better. We’re essentially making a liquid sling. Think infiltrating and getting ready to put in the mesh. That’s what we’re doing. Very simple, only we’re using a material that has never caused a granuloma ever. Doing that, frequently our patients will have their incontinence go away that day from the actual liquid and as it’s replaced with new tissue, it never recurs. Usually, you’ll have to repeat the procedure at a year or two out depending on the etiology. Sometimes it lasts longer.

    The interesting idea is what might be happening with those [inaudible 00:15:21]. They become more active, and does that help with sexual function? The other place we put it is in the actual corpus cavernosum of the clitoris. We use [inaudible 00:15:29] ultrasound visualization and see it flow down into the body of the clitoris by the pubic ramus and the wave form goes to what you see in a flaccid penis to what you see in an erect penis.

    Improved Orgasm & Libido in Women

    That’s my time, almost done. Just 30 more seconds. Here’s a pilot study we did where we showed that in women with female sexual distress, that it dropped by an average of 10 and female sexual function went up by 5 when you do what I just showed you. Here’s a study that Dr. Neto, who may be here, published where he looked at incontinence and sexual function down in Brazil and showed that 94% of the people loved it. The question here is how would you combine it with your energy source? It works great in the face if you do laser and follow it with PRP … better results, faster healing. Is it going to … We need people to help us work out the algorithms. Not everybody has laxity, but when you have something, when do you use which treatment and when do you combine it with PRP? We need those answers, because I don’t have them yet. This is possible helps.

    I am done. Thank you very much for having me. I put all these references at that website, if you want to go download them. Thank you. You guys have a wonderful conference.

    Dr. Marco Pelosi III: Thank you Charles. Beautiful

    More about the Cellular Medicine Association

    O-Shot® Research<–
    P-Shot® Research<–

    Upcoming Workshops With Live Models<–

  • Vegas2017

    Personal note from the inventor of the PRIAPUS SHOT® procedure…

    for physicians, nurse practitioners, sex educators, & physician’s assistants…

    Hello,

    Though I was the first physician in the world to use PRP to rejuvenate the human penis, though I invented the Priapus Shot® procedure, I count that as worthless unless many physicians and nurse practitioners actually learn to do the procedure and offer it to suffering men around the world.

    Inventor of the O-Shot (R) Procedure
    Charles Runels, MD
    Inventor of the Priapus Shot® Procedure

    If you are interested in learning about the procedure and applying to offer this procedure to your patients, please supply the following information. Partial information will not receive a response because I will not be able to check your credentials.

    Sex educators (and counselors) are critical to the healing process and I would be honored to also supply information to you (only physicians and their extenders can do the procedure since the procedure involves phlebotomy and injection of blood-derived growth factors).

    Thank you very much for your interest! I look forward to talking with you.

    Peace & health,

    signature-md

     

     

    Charles Runels, MD

    Please provide the following info so that I might send material to you immediately…

    • Watch a video describing how the Priapus Shot® procedure benefits both patients and providers
    • Free research about the Priapus Shot® mailed to your office.
    • Supporting scientific literature reviewed by video and with electronic file.
    • Access to my personal cell phone to answer your questions.

    Save

    Apply to Become Provider of the Priapus Shot® (P-Shot®) Procedure

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

    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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