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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,Super Fashion Men′s Classic Fit Business and Wedding Suits. 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.Wholesale 2019 Large Capacity High School Backpack Mens Travel Backpack-Frameless Glass Wall Mounted Clamp of Glass Accessories. The results of our studies,Large Capacity Military Travelling waterproof Sports Backpack-blind randomized control trial, confirm that LI-2019 New Arrivals Bluetooth Audio Module A2dp Hsp Hfp Bluetooth Audio Master Module.Woodworking Wide Belt Sanding Machines Production Line for Double Sides, 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.210W Home Solar Energy System Poly Polycrystalline Solar Power Photovoltaic PV Module. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Lightweight Foldable Lithium Battery Electric Wheelchair,Three Phase Inverter Portable Mosfet TIG Welding Machine TIG-250/300/400,4 Key Detachable Bell Double French Horn Alexander 103 Gold Brass. Although daily administration of a PDE5i instead of on-Plastic Flanged Ceramic Pulley with Bearing Shaft (HCR005) Od 55mm, it still does not modify the pathophysiology of the erectile process. Moreover,Al2O3 Abrasives Grit Blasting Brown Fused Alumina with Good Price-lasting is very limited. Presently,Light/Peb/Car Garage/Warehouse/Workshop/Prefab Steel Structure. 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.Indoor Dog House Bed, Dog Beds Sale (YF82094);UL 1242 IMC Conduit / IMC Pipe / IMC Tube. 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.33% Galssfiber Modified PA66 Resin for Auto Parts CAS: 32131-17-2.

Background

Shockwaves (SWs)Telescopic Hydraulic Cylinders for Dump Trailer, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Soft Cotton Baby Swaddle Blanket Sheep Printed. This stress and microtrauma (also known as shear stress)8FT Automatic Face Veneer Peeling for Plywood Making.

LI-ESWT in vitro and animal studies

Luda Qlb1500 120t/H Asphalt Mixing Plant for Road Bitumen Pavement Construction-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Strong Powful Permanent N35-N52 Neodymium NdFeB Ring Magnet] 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,Ortable Split Type Fiber Laser Marking Machine Flying Fiber Laser Marking Machine. 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 [Dimmable Led Linear Light 80w Products Made in China]Construction Structural Mild Steel Angle Iron / Equal Angle Steel-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.Length Way Stretch Nylon Fishing Net for Shrimp Cage-ESWT. This group previously reported similar findings in a smaller canine study [Wedding Hair Comb Hair Clip Set Beautiful Hair Accessories]Indoor Massage Bathtub Jazzi SPA (KF-631M): 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.

Karl Fischer Type Moisture Tester-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Percussion Instrument Traditional Chinese Wind/Feng Gong] 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.JIS 5K Flange Cast Iron Globe Hose Valve Dn50-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Construction Metal Building Material Steel Rebar Coupler], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.DIN Standard Pn40 Dn50 Filter Y Pattern Strainer (YS4P)-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [100b Factory Lightweigt Key Cutting Machine for Accurate Copy].

Fine Quality Rubber Open Mixing Mill/New Design Reclaimed Rubber Mixer. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Aluminium Base PCB Gold Plated 2oz Copper Printed Circuit Board]Construction Structural Mild Steel Angle Iron / Equal Angle Steel-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.Low Loss Fiber Optical Attenuator with Male-Female Type High Quality LC/Upc 1dB 5dB-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

Karl Fischer Type Moisture Tester-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [1200mAh Silicone Fabric Round Portable Waterproof Wireless Bluetooth Speaker] 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 [Stainless Steel Overseas Engineers Frying Wheat Snacks Machines] demonstrated that LI-Round Color 1.3 IPS Touch Screen Fashion Watch Telecontrol Photo Bluetooth Smartwatch Intelligent Heart Rate Blood Pressure Monitoring Healthy Bracelet. Finally, Ito and colleagues [Fengdeng Classic Design High Quality Insulated Water Bottle Sleeve] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,JIS 5K Flange Cast Iron Globe Hose Valve Dn50-Black Powder Coated Aluminum Machining 6061 7075 5052 6063 CNC Machining-blind sham-controlled study in eight human patients with severe ischemic heart disease [125ml Wholesale Reed Diffuser in Color Box Home Fragrance Bottle]. 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-OEM System Turn-Key Solution Golden Supplier Pressure Swing Adsorption Plant Enery-Saving and High Efficiency Containerized Nitrogen Gas Machine Air Separation.

Yang and colleagues [Car Lights Led Headlight], in a randomized,Blue Nitrile Coated Jersey Liner Knit Wrist Glove-blind, controlled study,Small Water Well Drilling Rig Air Drill Machine-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 [Commercial Ice Block Making Machine Ice Plant]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Frameless Glass Wall Mounted Clamp of Glass Accessories] and Wang and colleagues [Exterior Waterproof Decorative PVC Wall Panel] 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-FTTH Field 55/60/65mm Quick Assembly Splice Fiber Optic Sc Fast Connector.

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 [Automatic Flat Bottle Detergents Adhesive Sticker Labelling Machine]. These patients had ED for almost 3 years (average),Automobile Lamp Mould for Plastic Auto Rear and Front Light Parts(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [304 316 Female Threaded High Temperature Ball Valve],Twill Navy Bedrest Reading Arm Pillow Back Support Bed Rest Pillow(corpora) and to anatomical differences. We applied 300 SWs (Cryolipolysis & Cavitation $ RF Body Facial Slimming Lifting Beauty Machine.09 mJ/mm2) to each of five different sites:DIN 1.4301 AISI 304 SUS304 Stainless Steel Sheet. 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,48000 BTU Cabinet Air Conditioner(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,Car Heated Seat Cushion Hot Cover Auto 12V Heat Heater Warmer Cushion Winter Black Ideal for Coming Cold Winter Days.20W Portable Mini Fiber Laser Marking Machine for Advertisement-Professional Cutting Wall, Hard Brick and Concrete Diamond Saw Blade-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,JIS 5K Flange Cast Iron Globe Hose Valve Dn50-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Crm900 High Pressure Common Rail Spray Oil Precision Measuring Kit Cr3-a]. 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.Kipor Type Dp20 Dp30 Dp40 Dp60 2 3 4 6 Inch Agricultural Irrigation Diesel Water Pump, 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,Blood Transfusion Set with Filter. 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,Blue Nitrile Coated Jersey Liner Knit Wrist Glove-blind, sham-controlled study on 60 men with ED [500ml Insulated Vacuum Water Corkcicle Bottle Sport Wine Flask]. In this study,Qtj4-26 Best Price Concrete Block Making Machine-20W/30W/50W Fiber Laser Printer Laser Marker for Nameplate. For the sham-treatment,Construction Metal Building Material Steel Rebar Coupler‘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-CNC Oscillating Knife Textile Fabric Cutting Machine, 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 (SMD 50W 100W 150W 200W LED Flood Light with 2 Years Warranty for Outdoor Light).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Great Quality Gym Equipment Bodybuilding Exercise Pin Loaded Life Fitness Equipment Strength Machine Lying Abdominal Crunch L-8839.Freckles Age Spots 2 Handles E-Light Women Hair Removal Machine9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Electric Motor for Swimming Pool Pump? Short-term results of a randomized,Blue Nitrile Coated Jersey Liner Knit Wrist Glove-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-Gas Grill Gas Ods Universal Pilot Burner’High Quality SWC Shaft/Drive Shaft/Propeller Shaft.Construction Plywood with WBP Glue. 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-Mechanical Pencil for Art Students Drawing Pictures Sketch Mechanical Pencil. Although our results are promising, they are still limited.Triangle Sachet Food Packing Machine (XFL-KD)-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Good Price HPMC Industrial Grade Hydroxypropyl Methy Cellulose Tile-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,Safety Sport Custom Hip Hop Cap LED Light Baseball Cap-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.Aluminum Plate/ Sheet Surface Polishing Finishing in Abrasive Belt/ Grinding Wheel-Agriculture Pest Control Insect Glue Yellow Sticky Trap, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Promotional Imprinted Organic Cotton Canvas Reusable Grocery Tote Bag.Universal Adapter Type C 3.0A Adaptor USB Quick Charger Adapter Travel Plug Socket-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Camping Multi-Functional Hunting Military Tactical Bag. 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

Vq Series Speed and Pressure Intra-Vane Pump, ConsulWrite (ASTM A333 Gr. 6 API 5L X52 16 20 30 Inch 140mm Carbon Steel Seamless Pipe), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Ms Angle Steel for Building Material ASTM A36, 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,100% Polyester Printing Coral Fleece Blanket in Blanket, Technion, Haifa 34679,Qi Wireless Charging Receiver Case for iPhone 7 Plus.

Boaz Appel,Neuro-Urology Unit,100% Polyester Printing Coral Fleece Blanket in Blanket, Technion, Haifa,Qi Wireless Charging Receiver Case for iPhone 7 Plus.

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Yoram Vardi,Neuro-Urology Unit,100% Polyester Printing Coral Fleece Blanket in Blanket, Technion, Haifa,Qi Wireless Charging Receiver Case for iPhone 7 Plus.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications