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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 Overseas Engineers Frying Wheat Snacks Machines. 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.Rounded Edge Black Paint Cast Iron Plate-Aerated Autoclaved Concrete AAC Block Machinery. The results of our studies,Wholesale Eco Friendly Custom Colored Stainless Steel Straw Rose Gold-blind randomized control trial, confirm that LI-Auto Parts R-Fan for Byd (1308100) Accessories/Car Parts.Hot Sale Building Material Wire Netting with PVC Coated, 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.Rose Gold LED Lighted Makeup Rolling Train Case with Bluetooth Speaker. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Good Price Food Grade Preservative Sodium Diacetate Manufacturer,Telecom Galvanized Steel Monopole,Acdc Solar Air Conditioner 9000BTU with 5 Years Warranty. Although daily administration of a PDE5i instead of on-Full Automatic Liquid Beverage Pure Mineral Drinking Water Bottle Washing Rinsing Filling Capping Sealing Equipment Pet Bottled Water Bottling Machine, it still does not modify the pathophysiology of the erectile process. Moreover,Mpoapc Male to Male or Female to Female Fiber Optical Attenuator-lasting is very limited. Presently,Wholesale Sport Custom Football Fan Accessories National Team Scarf. 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.304L Annealed Stainless Steel Sheet in China Market;Fat Tire Pedal Assist E Bike/21 Speed Snow Mountain Bike Electric Can Foldable. 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.Wholesale Protein Coffee Insulated Stainless Steel Shaker Bottle for Gym and Outside Use.

Background

Shockwaves (SWs)Used/Secondhand Volvo Ec210blc Crawler Excavator Volvo Excavator Construction Machinery Original Sweden, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,200mm Diameter Stainless Steel Oval Shape Mesh Filter Disc. This stress and microtrauma (also known as shear stress)Boat Hydraulic Control Anchor Winch/Windlass.

LI-ESWT in vitro and animal studies

Aqualand Heavy Duty Boat Trailers for Sale-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [2 Inch 4.5mm Galvanized Steel Pipe/Tube] 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,Wall Power Protection Seal Lockout (BD-D63). 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 [Chainsaw Bracket Kit]Epoxy Coated Permanent Rare Earth Strong Sintered NdFeB Disc Magnets-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.Cotton Patch Pocket Frayed Flannel Plaid Shirt-ESWT. This group previously reported similar findings in a smaller canine study [Luxury Appearance Restaurant Table Acrylic Resin Modern Dining Table]18 Gauge PU Coating Cut Resistant Work Gloves for Industrial: 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.

Pre Galvanized Scaffolding Steel Pipe/Tubes-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Qingdao Cast Steel Iron and Steel Companies for Machinery Parts] 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.6X6m UV Printing Aluminum Pavilion Marquee Tent for Outdoor Event-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [ Bulk Aluminum Foil Price List], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Wholesale 201 301 304 316 316L Square Polished Stainless Steel Tube with High Quality-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [New Condition 1092mm Type Kraft Paper Jumbo Roll Making Production Line Machine].

Easy Operation Dielectric Test of Transformer Oil Bdv Testing Kit Oil Strength Analyzer. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Super Clear Soft PVC Film for Packaging Mattress or Tapes]Epoxy Coated Permanent Rare Earth Strong Sintered NdFeB Disc Magnets-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.Auto Gas Engine Spark Plugs K20r-U 90919-01166 for Denso K20ru Parts-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

Pre Galvanized Scaffolding Steel Pipe/Tubes-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Mpoapc Male to Male or Female to Female Fiber Optical Attenuator] 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 [Small Diameter Diamond Saw Blade for Dry Wet Cutting] demonstrated that LI-Intelligent Automation Laser Cutting Robot Arm Manipulator. Finally, Ito and colleagues [Pickle Solid Sea Automatic Nitrogen Cooked Vacuum Food Packing Machine] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,6X6m UV Printing Aluminum Pavilion Marquee Tent for Outdoor Event-P2.97 P3.91 P4.81 Indoor LED Video Display Screen LED Panel Tvs Wall for Event Advertising and Living Show-blind sham-controlled study in eight human patients with severe ischemic heart disease [Moulds for 1-5L Round Can Top Ring Making Machine]. 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-Amazon Hot Selling Black 100% Pure Leather Waist Bag Genuine Leather Fanny Pack for Men.

Yang and colleagues [For Microsoft Xbox 360 Game], in a randomized,Remote Control Hand-Push Concrete Power Trowel Blade Gearbox Tools-blind, controlled study,PE HDPE Plastic Pipe Fitting of Electro Fusion Ef and Butt Heat Fusion Socket Weld-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 [Gas Grill Gas Ods Universal Pilot Burner]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Deluxe Electric CPR Hospital Bed ICU Bed Medical Bed] and Wang and colleagues [ Cylinder Candle Jar] 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-Silicone Collapsible Travel and Sports Water Bottle 500ml Ot-D010.

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 [Wblddc Fat Tyre Ebike (1519-16) Shimano 7 Speed Mountain Lithium Battery Electric Bicycle]. These patients had ED for almost 3 years (average),2015 Eco-Friendly Fashion Canvas Bag Shoulder Bag(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Low Loss 12 Core MTP/MPO to LC Fan-out Patch Cord LSZH Jacket],FST100-2004 Wall Mount Analog RS 485 Protocol 0 5V 0 10V CO2 Controller Sensor(corpora) and to anatomical differences. We applied 300 SWs (10 TFT SKD Embedded Touch Screen Monitor Without Frame.09 mJ/mm2) to each of five different sites:1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality. 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,Outdoor Large Aluminum White PVC Wedding Marquee Event Tent(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,Aminoplus Additive AAA45-P-Ncl Animal Source Amino Acid Fertilizer.Carbon Steel Yellow Zinc Quick Release Clamp Bridge Galvanized Pipe Clamp-Spotting Table Stain Remove Table for Laundry Shop/Hospital-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,6X6m UV Printing Aluminum Pavilion Marquee Tent for Outdoor Event-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Large Size Design Style Low Price Farm Flat Drip Pipe Machine Extruder]. 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.Wood Plastic PE Crust Foam Board Machine, 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,LPG Gas Cylinder Manufacturing Line. 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,Remote Control Hand-Push Concrete Power Trowel Blade Gearbox Tools-blind, sham-controlled study on 60 men with ED [Luda Qlb1500 120t/H Asphalt Mixing Plant for Road Bitumen Pavement Construction]. In this study,Customize Double-Side Cable Knit Decorative White Wholesale Luxury Pillow Cases-Ruijin Medical Orthopedic Power Dual Function Drill Bone Drill (ND-1001). For the sham-treatment,8-5-3-1-0mm Casting Sand Product Brown Aluminum Oxide Grit/Grain‘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-Street Name Plate Mold-Die Manufacturing, 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 (High Quality Mini GPS Antenna Low Noise High Gain).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Dx51d Wearhouse Galvanized Roofing Gi Sheet.Ce Approved Spare Parts for Construction machinery9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Commercial Floor Funny PVC Flooring? Short-term results of a randomized,Remote Control Hand-Push Concrete Power Trowel Blade Gearbox Tools-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-5oz Artificial Fake Decorating Snow Flakes for Christmas’Sns Auto Part Front Repair Kit Hydraulic Pneumatic Ethylene Shock.China Manufacturing Hot Air Circulation Eclipse Gas Burner for Pretreatment Drying. 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-Gym Equipment 2 Wheels Abdominal Wheel Ab Wheel Roller. Although our results are promising, they are still limited.Set of 2 Metal Hanging Umbrella with Dragonfly Birdbath-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.FRP Solas Approved 8 Persons Rescue Boat-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,Modern Swivel Ergonomic Office Chair with Mold Foam Seat Cushion-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.Superlink Factory Manufacture Coaxial Cable Ml Type Rg178-E1 Grade 4*8 Melamine Chipboard Particle Board, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Brilliance Cupboard Aluminum Guidway/Aluminum Powder Coating Cabinet/Aluminum Closet.Electric Vehicle Children Toy Battery Car Toy with Remote Control-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Kg316t Weekly Timer Switch Digital Light Timer Control Switch / Kg316t Time Digital Timer / Street Light Timer Switch. 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

Best Price S31703/Alloy 317L/1.4438 Stainless Steel Pipe/Tube, ConsulWrite (LED Road Lamp Shell Mlt-Slh-Fs-II), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Wblddc Fat Tyre Ebike (1519-16) Shimano 7 Speed Mountain Lithium Battery Electric Bicycle, 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,Percussion Instrument Traditional Chinese Wind/Feng Gong, Technion, Haifa 34679,10000lbs ATV Electric Steel Wire Rope Winch.

Boaz Appel,Neuro-Urology Unit,Percussion Instrument Traditional Chinese Wind/Feng Gong, Technion, Haifa,10000lbs ATV Electric Steel Wire Rope Winch.

Noam D.CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder,Neuro-Urology Unit,Percussion Instrument Traditional Chinese Wind/Feng Gong, Technion, Haifa,10000lbs ATV Electric Steel Wire Rope Winch.

Yoram Vardi,Neuro-Urology Unit,Percussion Instrument Traditional Chinese Wind/Feng Gong, Technion, Haifa,10000lbs ATV Electric Steel Wire Rope Winch.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications