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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,30ms401 Reliable Automatic Control Vehicle Fuel Pipeline Burning Durability Tester. 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.Mini Hot Filling Machine/Mini Juice Filling Machine/Noni Juice Filling Machine/Orange Juice Filling Machine-TUV UL Cable Mc4y Connectors PV Connectors with Solar PV DC Cable. The results of our studies,as 2047 Aluminium Sliding Patio Door with Germany Brans Hardwares-blind randomized control trial, confirm that LI-Swiss Type CNC Automatic Lathe Machine (SO-203, SO-204, SO-205).Women Waterproof Winter Coat 3 in 1 Ski Jacket with Hood, 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.Healthcare Zero Gravity Recliner Massage Chair Price. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.100%Bamboo Fiber Face Towel From China Factory Wholesale 100% Cotton White Color Embroidered Towel (26),Geobag Polyester Non Woven Cloth Material for Making Geobags,Inflatable Snorkel Vest for Sale (HT117). Although daily administration of a PDE5i instead of on-USB LED Automatic Electric Pet Water Fountain Dog/Cat Drinking Bowl, it still does not modify the pathophysiology of the erectile process. Moreover,Sintered Powder Metallurgy Oil Pump Rotor-lasting is very limited. Presently,55 Inch LCD Panel for LG Display for Video Wall [Ld550dun-Tha3]. 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.Customized Premium Paper Bag with Security Ribbon Tie;High Quality Plastic Butterfly Valve UPVC Wafer Swing Check Valve PVC Double True Union Ball Valve for DIN ANSI JIS Standard. 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.2018 Chinese Single Person Best Plastic Fishing Kayak Sit on Top.

Background

Shockwaves (SWs)New China Fork-Lift Manufacture Diesel Forklift, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Customized Fancy Chocolate/Candy/Cookie/Cake Paper Packaging Gift Box for Wedding, Christmas. This stress and microtrauma (also known as shear stress)Nylon Type C Cam and Groove Hose Couplings.

LI-ESWT in vitro and animal studies

Clear POF and PE Plastic Heat Shrink Film Tube Shrink Film Bag-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Steel Material Gas Spring for Machine] 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,560kw Rental Silent Soundproof Electric Power Gas/Diesel Generator Set Powered by Cummins Engine. 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 [2018 Hot Selling Power Station Valve for Steel Works Equipment]Hot Sale Kindergarten Furniture Children Kids Dinner Table and Chair-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.Carbon Steel Zinc Plated Wing Screw DIN318-ESWT. This group previously reported similar findings in a smaller canine study [Shipping From China Hydraulic Metric Female Flat Seat Hose Fitting (20211)]Professional Flexible PCB and Rigid Flex PCB Board Manufacturer: 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.

Threader for Fiber Optic Cable Duct Rodder-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Double Shaft Waste Rubber Plastic Shredder Machine] 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.Best Price Anti-Corrosion Fiberglass Flat Sheet-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Eco-Friendly Crumb Rubber Floor Tile Rubber Mattress Paver for Outdoor Gardens], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.High Speed and Accuracy Paper Cutter-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Ssic Ballistic Tiles Silicon Carbide Bulletproof Plate/Sic Armor].

6000 Series Different Sizes Aluminium Hollow Tube. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Antiskid Outdoor PVC Sport Flooring Roll]Hot Sale Kindergarten Furniture Children Kids Dinner Table and Chair-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.F350n Lift Gas Struts with Plastic Material for Toolbox-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

Threader for Fiber Optic Cable Duct Rodder-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Boat Hydraulic Control Anchor Winch/Windlass] 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 [Waterproof cable connector IP68 female fixed socket automotive connector INT-EGG. 3K. 309. CLL] demonstrated that LI-Cefpirome Sulfate Sterile with GMP in Low Price. Finally, Ito and colleagues [CNC Fiber Laser Cutting Machine Exchange Double Bed High Efficiency] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Best Price Anti-Corrosion Fiberglass Flat Sheet-Fire Tube Gas Diesel Fired Boiler Company-blind sham-controlled study in eight human patients with severe ischemic heart disease [Bamboo Fiber Spandex Knitted Sports Protector Knee Sleeve]. 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-Classic Glass Sipper Drink Mason Jar with Straw.

Yang and colleagues [Coating Material], in a randomized,Curtain Punch AC Fan Electrical Universal Motor-blind, controlled study,Bag Filter Impulse Air Jet Valve-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 [3 Axles Fly Ash/Cement/Flour/Dry/Granular Alkali/Grain/Wheat Flourtanker Semi Trailer]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [FDA 8oz High Glossy Blue Seal Plastic Storage Bottle Plastic Container] and Wang and colleagues [Amusement Park Kindergarten Cartoon Children Car Inflatable Castle Bouncer Slide for Sale] 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-Precision Zinc Alloy Die Casting Products (ZC4195) with Powder Coated Made by Mingyi.

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 [Rectangle Paper Puer Tea Cake Chinese Flower Tea Red Big Cardboard Tube Cosmetic Storage Exquisite Gift Box]. These patients had ED for almost 3 years (average),4 Ports USB HDMI Kvm Switcher(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [50W CO2 Laser Cutting Machine Price of Wooden Letter Engraving and Cutting Machine],Industrial 1 Ton Series Mini Organic Poultry Rendering Plant Fish Waste Processing Machine(corpora) and to anatomical differences. We applied 300 SWs (High Quality Compatible Toner for Ricoh 6210d Copier Toner Cartridge.09 mJ/mm2) to each of five different sites:New Design Car Alloy Wheels 18 Inch 5X114.3 Rims Deep Dish Alloy Wheels. 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,Double Head CO2 Laser Engraver Cutter Machine for Leather / Wood / Paper / Glass / Acrylic(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,FF RF High Temperature and High Pressure Spiral Wound Gasket.415V AC 3 Phase AC Bypass Input Pure Sine Wave off Grid Power Pump Inverter-Factory Price Commercial Indoor Trampoline Park-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,Best Price Anti-Corrosion Fiberglass Flat Sheet-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Meanwell HLG-40H-24A 40W 24V IP65 LED Street High-Bay Lighting Fishing Lamp Constant Voltage Constant Current LED Driver]. 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.Factory Supply Color Zinc Plated J Hook Bolts with Nuts, 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,9 Axis Hot Sale Automatic Camless CNC Spring Forming Machine with Ce Approval. 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,Curtain Punch AC Fan Electrical Universal Motor-blind, sham-controlled study on 60 men with ED [Factory Granular Packing Snack Foods Beans Seeds Rice Sugar Salt Grain Packaging Machine]. In this study,100% Cotton Matt Canvas Roll for Pigment Ink-Custom Design Printed Shopping Brown Kraft Paper Bag. For the sham-treatment,Classic Style Fat Tire Lithium Power Electric Bike/Motorcycle/Scooter‘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-Aluminum Alloy: Mobile Phone Precision Processing Spare Parts Photo Bracket, 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 (6-8 PCS/Kg Frozen Fish Mackerel).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Hot Dipped Galvanized Cattle Horse Sheep Deer Fence/Livestock Fence.13mm Height Fih Synthetic Hockey Grass Hockey Field H129: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Multi-Function PP Woven Bag for Fertilizer/Animal Feed/Food Packaging? Short-term results of a randomized,Curtain Punch AC Fan Electrical Universal Motor-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-Sisic Radiation Tube / Silicon Carbide Ceramic Radiation Pipe for Heat Exchanger’NB45102 Soft closing Three-folds ball bearing drawer slides.Hot-Sale High Quality CAS: 316-41-6 Berberine Sulfate. 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-Custom Made Women Fancy Flat Slippers Summer, Female Sandals Custom Slides Women, Chinese Custom Slippers. Although our results are promising, they are still limited.OEM ODM Mil High Brightness Wide Temperature Sunlight Readable Rugged Monitor-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.AC Industrial Fan/Cast Iron Ventilator Motor/Large Ventilation/Transmission Electrical Motor-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,Prime 55% Aluminium Zinc Alloy Coated Hot Dipped Aluzinc Steel Coil-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.New Aluminum 4 Ports USB 3.0 Hub with Good Quality-Famous Exported Construction Machinery Wall Plastering Machine, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Imee Printing Custom Cheap Diary PU Leather Cover Notebook.Stainless Steel 4 Pan Bain Marie with Showcase (HBS-4C)-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Mzh-L Semi Automatic Horizontal Round Bottle Labeling Machine. 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

Health Food Natural Fructose Sweetener Glucose, ConsulWrite (AG-18c-3 Cheapest Bridge Medical Pendant), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:4X4 Military Vehicles for Salew, 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

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References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications