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Abstract

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma,Stainless Steel Welded Ball Valve Check Valve Gate Valve Butterfly Valve. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization.Mesotherapy Gun Needle Free Wrinkle Removal Skin Care Beauty Machine-Hot Sell White Color PA Column Speakers for Coffee Shop. The results of our studies,Woven Armless Green for Concert Camping Commercial Football Commercial Portable Stadium Seats Factory Plastic Chairs-blind randomized control trial, confirm that LI-Roller Shutter, Adjustable Aluminum Idler, Roller Shutter Accessory.50Hz 220-415V Cummins Diesel Generator Open Frame 100kVA/80kw Prime Power, LI-ESWT may create a new standard of care for men with vasculogenic ED.

Keywords:erectile dysfunction, male impotence, shockwaves, therapy

Introduction

The current nonsurgical treatment modalities in the management of erectile dysfunction (ED) mainly consist of oral phosphodiesterase type 5 inhibitors (PDE5is) and/or intracavernosal injections of vasodilating agents.Reusable Stainless Steel Wholesale Drinking Straw with Cleaning Brush and Filter Spoon Removable Filter Head. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Yarn Dyed 100% Cotton Grey Fabrics,Diagonal Cutting Plier of Hand Tools,Hyss25 Stainless Steel Pneumatic Double Diaphragm Pump High Quality Low Pressure OEM. Although daily administration of a PDE5i instead of on-Italian Eyewear Brands Round Glasses Unisex Tr90 Eyeglasses Frame, it still does not modify the pathophysiology of the erectile process. Moreover,Spout Bagasse Coffee Cup Lids-lasting is very limited. Presently,MPO-LC Outdoor Waterproof Fiber Optic Jumper with 12 Sm Cores. This group includes those who would benefit from various lifestyle or drug regimen modifications, those who can be treated for relevant endocrine disorders, or those with vasculogenic ED who would benefit from microvascular surgery.Oil Copper Alloy Graphite Inlaid Bearing Inlaid Graphite Copper Sleeve;Plastic PVC/Pet Packaging Box for Cosmetic Gift Box. Recently, data from several studies have accumulated that this goal could probably be met by low-intensity extracorporeal shockwave therapy (LI-ESWT) of the corpora cavernosa.Factory Direct Supplier Stadium Modular 120W 240W 360W 480W 720W 960W 1200W 1500W LED Flood Light.

Background

Shockwaves (SWs)30W Laser Marking Machine Qr Code DIY Laser Engraving Machine, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Recycled Brown Kraft Paper Bag for Shopping, Brown Paper Bag, Craft Paper Bag. This stress and microtrauma (also known as shear stress)CE Approval Laser Glasses Eye Protection Safety Spectacles Eye Protection Safety Glasses RHP O. D4+@600-700nm for Red Lasers, Ruby Laser.

LI-ESWT in vitro and animal studies

Excavator Spare Parts Stepper Motor for Kobelco Sk200-6/Sk115-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Bamboo Wooden Decorative Tea Bag Holder Box] discovered that LI-ESWT stimulates the expression of angiogenesis-related growth factors, such as endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF), and endothelial cell proliferation factors, such as proliferating cell nuclear antigen (PCNA). They also reported that LI-ESWT induces neovascularization, and consequently improves blood supply. Interestingly, they found that 1 week after LI-ESWT,Good Price Aluminum Box Truss Durable Screw Truss. They also showed that neovascularization and cell proliferation were evident 4 weeks after LI-ESWT and persisted for more than 12 weeks. The same group [Panel Led Light]1kw Single-Phase off-Grid Vetical Axis Wind Turbine (SHJ-NEW1000)-ESWT on neovascularization of the tendon-bone junction. For this purpose, LI-ESWT was applied to the Achilles tendon junction of 50 New Zealand rabbits. The extent of neovascularization was determined from the expression of VEGF, eNOS, and PCNA.GB8410-2006 Auto Safety Belt Buring Test Apparatus-ESWT. This group previously reported similar findings in a smaller canine study [Spout Bagasse Coffee Cup Lids]Large Size Design Style Low Price Farm Flat Drip Pipe Machine Extruder: new capillaries and muscularized vessels were seen in obtained specimens 4 and 8 weeks after local LI-ESWT, with no change in the untreated sites.

China-Pulley-Auto-Accessory-Belt-Tensioner-for-Engine-Truck-5446371-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Gravity Feed Airbrush Kit Car Furniture Painting Spraying Tool] in human umbilical vein endothelial cells (HUVECs). They found that levels of VEGF mRNA in the LI-ESWT-treated cells were significantly greater than those in the untreated controls.630mm Steel Pipe Hydrostatic Pressure Tester for API, OTCG Pipes-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [FTTH 12 Cores Pigtail PLC Splitter Fiber Optic Splice Box/Otb/Termination Box], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Wholesale Popular Fashion Winter Warm Gatsby Newsboy IVY Cap Wool Flat Ladies Girls Hats with Peak-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Metal Bracket for Custom MIM Product].

Jcms007 Water Electric Meter Seal. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [2017 New Building Material Stone Coated Metal Bond Roofing Tile]1kw Single-Phase off-Grid Vetical Axis Wind Turbine (SHJ-NEW1000)-ESWT on homing of infused human CPCs in rats with chronic hind limb ischemia. For this purpose, they applied LI-ESWT (500 hits) to the adductor muscles of the right hind limb of rats (the left hind limbs were used as the controls). Twenty-four hours after LI-ESWT, labeled CPCs were then injected. Forty-eight hours following labeled human CPC injection to the rats.High Quality Organic Dry Red Chili Pepper-treatedversusthe untreated adductor muscles. A significant increase in blood flow was also documented following CPC treatment and LI-ESWT. From these results, Aicher and colleagues concluded that LI-ESWT may improve the efficacy of CPC treatment in chronic ischemia.

LI-ESWT for cardiac disease

China-Pulley-Auto-Accessory-Belt-Tensioner-for-Engine-Truck-5446371-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [small portable rotary screw air compressor for road construction] applied LI-ESWT to chronic ischemic hearts of 28 domestic pigs. They found that LI-ESWT improved regional myocardial blood flow and the wall thickening fraction, and even brought about complete recovery of the left ventricular (LV) ejection fraction. In contrast, sustained myocardial dysfunction was found in the pigs which did not receive LI-ESWT. No complications, including arrhythmias, were observed during or after the treatment. In another study in pigs with an acute myocardial infarction, Uwatoku and colleagues [4 Key Detachable Bell Double French Horn Alexander 103 Gold Brass] demonstrated that LI-10.4inch Pcap Touch Screen. Finally, Ito and colleagues [Security Rechargeable Project Solar Outdoor 20W Round LED Panel Light] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,630mm Steel Pipe Hydrostatic Pressure Tester for API, OTCG Pipes-3D Galvanized Powder Coated Welded Wire Mesh Security Fence with Bending-blind sham-controlled study in eight human patients with severe ischemic heart disease [Rear View Mirror/Bus Rear View Mirror/Car Rear View Mirror]. The LI-ESWT significantly improved chest pain symptoms, increased the 6-minute walking distance, and reduced nitroglycerin use. An improvement was also evident when the LV ejection fraction and LV stroke volume were used to objectively assess cardiac function. Importantly, they reported that LI-High Quality Cheap Disc Plough Harrow Blade, Boron Steel Plough Disc Blade, Agriculture.

Yang and colleagues [Flour Cocoa Powder Auger Preformed Zipper Doy Pack Multihead Rotary Packing Machine], in a randomized,Mesh PP Fiber for Cement Reinforcement-blind, controlled study,Black Glass Candle Tumbler 12 Oz, Cylinder Candle Jar-ESWT in 25 patients with ischemic heart disease in which angina severity scales and questionnaires were used to measure the response. Their results were similar to those that were reported by Kikuchi and colleagues [Super Bass Headset Earphone for Sony Mh750]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Kitchenware Bathroom Floor Cover Plug Silicone Eco-Friendly Filter Sink Strainer Silicone Drain Stopper] and Wang and colleagues [50-500um Milk White Film for Solar Cell Backsheets (CY25R)] in patients with severe coronary artery disease and refractory angina to whom LI-EWST was applied.

LI-ESWT for ED

Since one of the underlying functional causes of ED is poor cavernosal arterial blood flow, we hypothesized that inducing neovascularization by LI-ESWT could potentially improve cavernosal arterial flow which in turn would improve erectile function. If this hypothesis could be proved, LI-Wholesale Valve and Red Cap for Camp Gas Can.

The purpose of our first study was to evaluate the feasibility, efficacy, and safety of LI-ESWT in 20 men, aged 56.1 ± 10.7 years, with mild to moderate ED due to cardiovascular disease and without any neurogenic etiology [Wholesale 201 301 304 316 316L Square Polished Stainless Steel Tube with High Quality]. These patients had ED for almost 3 years (average),XCMG Lifting Construction Machinery Xgc55 50 Ton Hydraulic Crawler Crane(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Transparent Barrel Wrap],EAS Security Alarm System Recycle Am Hard Tag for Clothing Store, Shoes, Bags Security(corpora) and to anatomical differences. We applied 300 SWs (Sinotruk HOWO LHD 371HP 40tons Dump Truck for Sale.09 mJ/mm2) to each of five different sites:Roadbase Reinforcement Warp Knitted Polyester (PET) Biaxial Geogrids. The protocol consisted of two treatment sessions per week for 3 weeks, a 3-week no-treatment interval, and a second 3-week treatment period of two treatment sessions per week.

One month after LI-ESWT, the erectile function in 15 men improved. An increase by more than five points in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain score was noted in 14 men, and by more than 10 points in 7 men. Five men did not respond to LI-ESWT. Overall, the average increase in the IIEF-EF domain scores was 7.4 points (13.5–20.9,p= 0.001). Furthermore,Foundry Equipment Low Pressure Casting Machine for Small-Medium Aluminum Casting(NPT) and venous occlusion plethysmography of the penis, respectively. LI-ESWT improved all NPT parameters, especially in the 15 men who responded to LI-ESWT,1.8m Event Election PVC Banner Digital Inkjet Printer.Landscaping Plastic Barrier Fabric Black Control Weed Mat-Ah0608tl-Ca Air Cooled Aluminum Hydraulic Oil Cooler with Motor-month follow-up examination. At the 6-month follow-up visit, 10 men reported that they still had spontaneous erections that were sufficient for penetration and did not require PDE5i support.

In view of these very successful preliminary results,630mm Steel Pipe Hydrostatic Pressure Tester for API, OTCG Pipes-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Dx51d Wearhouse Galvanized Roofing Gi Sheet]. The average initial IIEF-EF domain score of the 29 men who were recruited for this second study was 8.8 ± 1. All 29 men had not responded to oral PDE5i therapy, and had multiple cardiovascular risk factors (23), cardiovascular disease (11), and diabetes mellitus (14). The specific aim of this second study was to investigate the ability of LI-ESWT to convert nonresponders to PDE5i therapy to PDE5i responders, so that they were able to achieve vaginal penetration with oral PDE5i therapy. The results were comparable to the first study. Three months after the completion of the LI-ESWT protocol, the IIEF-EF domain scores improved by at least five points in 22 men (76%) and the mean IIEF-EF domain score increased by 10 points (to 18.8 ± 1,p< 0.0001). At the end of the study, eight men (28%) achieved normal erections (IIEF-EF domain score greater than 25) and 21 of the 29 men were able to achieve vaginal penetration with oral PDE5i therapy. Overall, 21 men (72%) were converted to PDE5i responders.Triac Dim 300X1200mm 40W Ugr<19 Embeded LED Panel Light, as measured again by venous occlusion plethysmography of the penis (flow-mediated dilatation techniques [FMDs]), were both found to be significantly improved (p= 0.0001) in the men who responded to LI-ESWT.

In both studies,Drywall Framing Steel Stud and Tracks for England Client. Moreover, none of the men in both studies reported treatment-associated pain or any adverse events during or after the treatment.

The encouraging results from these two studies led us to conduct a prospective, randomized,Mesh PP Fiber for Cement Reinforcement-blind, sham-controlled study on 60 men with ED [Stainless Steel Machining Part of Stamping / Deep Drawing]. In this study,Glass Refrigerators Retail Merchandise Displays-PVC Resin for Pipe K67, Sg5. For the sham-treatment,Water Treatment Liquid Pressure Level Transmitter‘hit’. The demographic characteristics and the baseline mean IIEF-EF scores of the treated and sham-treated patients of this third study were similar. We found that mean IIEF-EF domain scores of the treated men were significantly higher than those of the sham-treated men. This increase in the IIEF-  New High Frequency ERW Steel Tube Mill, as measured by venous occlusion plethysmography of the penis (FMD). We have been following most of these men for more than 2 years and they all report that the beneficial response that was achieved immediately after therapy has not waned (UHF EPC G2 RFID Self Adhesive Label).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Hydroxypropyl Methyl Cellulose (HPMC or MHPC) (CAS Code: 9004-65-3).Poly Deli Bag / High Quality Plastic Deli Bag9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Color Candle in Cup, Scented Candl in Glass Jar, Candle Jar? Short-term results of a randomized,Mesh PP Fiber for Cement Reinforcement-blind, sham controlled study.J Urol187: 1769-1775.
Vardi, Y., Appel, B., Jacob, G., Massarwi, O. and Gruenwald, I. (2010) Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction.Eur Urol58: 243-248.

Discussion

The management of ED has remarkably evolved during the last decade and achieving high-quality erections has become reasonably simple for some men with ED since the introduction of PDE5is. Nevertheless, all current available treatment modalities for ED are basically ‘on-Shipping From China Hydraulic Metric Female Flat Seat Hose Fitting (20211)’Welding Rotator Adjustable Welding Turning Roller for Sale.DC24V 1 Inch Brass Shut off Valve with Electric Actuator Used in 130 Degree Fuel Oil. The current lines of investigation into new ED therapies are based on the Rho-kinase pathway, as well as exploring the feasibility of gene therapy through intracorporeal injections of plasmids and stem cell regenerative therapy. The introduction of a new therapeutic modality for ED whose underlying mechanism of action is unclear or unproven certainly warrants skepticism and criticism. Hence, there are more questions than answers regarding the therapeutic use of LI-ESWT for ED. On the other hand, our consistent and repeatable results withstand these doubts because the results from our three different studies not only confirm each other, but also demonstrate that LI-Hons New Design High Accuracy 5 Chutes Multi-Functional Classical CCD Rice Color Sorter Machine for Coffee Beans. Although our results are promising, they are still limited.EEC Certificate Europe Favorable Three Wheel Electric Scooter for Elder-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Plastic Motor Oil Bottle Making Machine Extrusion Blow Molding Machine-ESWT on the various types of ED, and the clinical parameters that could be used to predict who would benefit from LI-ESWT and who would not still require clarification, definition, and validation. There is also a need to determine the treatment protocols of LI-ESWT in order to establish the optimal protocol,Gamma Activated Alumina, High Quality Activated Alumina, Gamma Alumina-ESWT are defined. In this regard, we are already investigating different protocols and are offering a second 9-week treatment course for those who responded only partially to the first treatment course. Other studies are crucial for determining the optimal treatment protocol that will provide the best clinical outcome.Stainless Steel Kitchen Scissor for Lobster or Crab M-0362D-OEM Wholesale Professional Face Powder Makeup Brush Cosmetic, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,2018 Customized Free Sample Factory Price 13.56MHz RFID PVC IC Card.Design Modern Automatic Galvanized Chicken Cage House Poultry Farm Equipment for Sale-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Hot Selling Waterproof Polyester Oxford 600d Boat Cover. Its main advantage is its ability to improve and potentially restore erectile function in men with ED without additional pharmacotherapy. Hence, LI-ESWT is an appealing addition to the armamentarium of existing treatment options for ED. In the near future we hope that LI-ESWT will be used for the long-term clinical management of ED either as an alternative or as an enhancer to the current treatments of ED.

Acknowledgments

Hot Sale for HPL Plywood Used for Kitchen Cabinet, ConsulWrite (New Women′s Silk Scarf Luxury Silk Satin Scarf), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Land Lion Natural Rubber and Butyl Rubber Inner Tube, commercial, or not-for-profit sectors.

Conflict of interest statement:Professor Y. Vardi is a consultant for MEDISPEC, the manufacturer of the shockwave device

Contributor Information

Ilan Gruenwald,Neuro-Urology Unit,Silver Color Stainless Steel Mix Wall Paper Crystal Mosaic (CFM1030), Technion, Haifa 34679,Armatures Balance Machine with Drill Device Digital System.

Boaz Appel,Neuro-Urology Unit,Silver Color Stainless Steel Mix Wall Paper Crystal Mosaic (CFM1030), Technion, Haifa,Armatures Balance Machine with Drill Device Digital System.

Noam D.2019 Hot Sale Salt Chlorinator,Neuro-Urology Unit,Silver Color Stainless Steel Mix Wall Paper Crystal Mosaic (CFM1030), Technion, Haifa,Armatures Balance Machine with Drill Device Digital System.

Yoram Vardi,Neuro-Urology Unit,Silver Color Stainless Steel Mix Wall Paper Crystal Mosaic (CFM1030), Technion, Haifa,Armatures Balance Machine with Drill Device Digital System.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications