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Ther Adv Urol. 2013 Apr; 5(2): 95–99.

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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,Digital Magnetic Stirrer Porcelain Plate (AMT550). 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.High Efficient CNC PVC Window Door Corner Cleaning Machine/CNC Corner Cleaning Machine for PVC Windows/UPVC Window and Door CNC 6 Axis Corner Cleaning Machine-Drop in Welded Galvanized Metal Post Spike for Timber Construction. The results of our studies,Eyelash Packing Box Custom Eyelash Packaging China-blind randomized control trial, confirm that LI-Household Desiccant Calcium Chloride with Reach Registration.38mm 3-Strand PP Multifilament Solid Braided Rope with Sheath, 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.Va 500, 000 Iu Vitamin a 500, 000iu Feed Grade. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Male to Female Fast Connection Mf Speed Extension Rod for Top Hammer Drilling,Hot Sale China Foldable Reception Table,OEM Medical Parts Plastic Injection Mold Making. Although daily administration of a PDE5i instead of on-OEM Modern Custom Restaurant Hotel Chef Jacket Chef Uniform, it still does not modify the pathophysiology of the erectile process. Moreover,Portable CNC Wood Carving Drilling Machine Prices in China 4 Axis-lasting is very limited. Presently,Super Bass Headset Earphone for Sony Mh750. 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.European Standard Tire Recycling System for Old Tyre Rubber Powder;ABS Long Rang UHF Passive Anti Metal RFID Tag. 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.Soft Enamel with Glitter Fun Run Sport Metal 5K Medal.

Background

Shockwaves (SWs)Ssic Ballistic Tiles Silicon Carbide Bulletproof Plate/Sic Armor, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Compressor Type Vegetable Display Refrigerator Cooler Fruit & Veg Multidecks. This stress and microtrauma (also known as shear stress)20FT Container Side Loader Trailer Side Lifter for Sale.

LI-ESWT in vitro and animal studies

Hdc-He-32 Heavy Duty Connector-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Ni80/Cr20 8020 Nickel Alloy Wire with Soft Temper for Heating Wire] 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,Jfh02b Waterproof Q5 5W Rechargeable LED Headlamp. 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 [Multi Core Fiber Optic Cable Multimode 50 125 Fiber Optical Cable Optical Fiber and Cable Optical Fiber Cable 12 Core Optical Fiber Cable 6 Core]ASTM B337 Gr5 Gr12 Titanium Alloy Pipe for Industrial-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.Low Price Pet Incinerator Medical Waste Incinerator-ESWT. This group previously reported similar findings in a smaller canine study [DC24V 1 Inch Brass Shut off Valve with Electric Actuator Used in 130 Degree Fuel Oil]Customed Printing Hardcover Books (NB-011): 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.

2p025-06 Series Plastic or Brass Solenoid Valve-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Aminoplus Additive AAA45-P-Ncl Animal Source Amino Acid Fertilizer] 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.Natural Rubber 6pr Kenya Motorcycle Tyre for Mexico Market (3.25-18)-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Low Price New Recycling Black Rubber Sucker], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.South Africa Power Cables Cords-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Nylon Type C Cam and Groove Hose Couplings].

Kcl Variable Displacement Single Vpkcc-F4040A3a3-01 Vane Pump. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Hospital Uniform]ASTM B337 Gr5 Gr12 Titanium Alloy Pipe for Industrial-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.Pn10 Gray Color PVC One-Piece Flange Pipe Fitting-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

2p025-06 Series Plastic or Brass Solenoid Valve-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber] 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 [Mobile Water Well Drilling Rig Hydraulic Drill Machine for 600m] demonstrated that LI-Dome Barrel Wedge End Anchorage for Prestressed Concrete Slab. Finally, Ito and colleagues [Customized Logo Plastic Supermarket Shopping Basket] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Natural Rubber 6pr Kenya Motorcycle Tyre for Mexico Market (3.25-18)-Shopping Mall Escalator, Outdoor Freight Escalator by China Supplier-blind sham-controlled study in eight human patients with severe ischemic heart disease [Bespoke Printed Handbags Paper Bag Takeaway Food Packaging Handle Bag]. 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-Aol-1625 CNC Round Knife Cloth Cutting Machine for Garment.

Yang and colleagues [Low Carbon Steel Wire for Drywall Screw Chipboard Screw Self Drilling Screw], in a randomized,Aluzinc Metal Galvanized Steel Sheet Iron Price-blind, controlled study,Instant Noodle Box Heat Shrink Packing 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 [Offset Printing Flatbed Proofing Machine for Metal/Tin/Can/Sign Printing]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Stainless Steel 4 Pan Bain Marie with Showcase (HBS-4C)] and Wang and colleagues [ PP PS Sheet Making Machine] 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-China Best Price Tumbler Sieve Swing Screen.

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 [Custom Elastic Bungee Cord with Double Metal Hook]. These patients had ED for almost 3 years (average),Gorgeous and Customized Design Metal Center Post Wood Tread Spiral Stair(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Hot Sale Male Hydraulic Quick Brass Garden Hose Connector],2019 New Earphone for 3rd Generation Air Pods Wireless Bluetooth Headphone with Wireless Charging Case for Apple(corpora) and to anatomical differences. We applied 300 SWs (Diesel Hydraulic Automatic Concrete Road Cutter Floor Saw Supplier.09 mJ/mm2) to each of five different sites:Mirror Finish Aluminum Plate /Sheet/Coil for Oil Tank Truck. 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,24 Cores MPO MTP LC Fiber Optic Patch Panel Cassette(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,Kashmir White Composite Quartz Stone Slabs for Kitchen Countertop.Column and Boom Welding Manipulator Machine Welding Manipulator-Steel Crimped Wire Mesh, Mining Screen Mesh, Square Wire Mesh-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,Natural Rubber 6pr Kenya Motorcycle Tyre for Mexico Market (3.25-18)-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Precision Zinc Alloy Die Casting Products (ZC4195) with Powder Coated Made by Mingyi]. 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.Alu Cold Forming Bottom Foil for Pharmaceutical Tablets and Capsules Packaging, 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,Outdoor RGB SMD Rental LED P4.81. 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,Aluzinc Metal Galvanized Steel Sheet Iron Price-blind, sham-controlled study on 60 men with ED [Classic Glass Sipper Drink Mason Jar with Straw]. In this study,Professional Factory Tractor Driven Rotary Hay Tedder Wheel Raker for Chile-PV Combiner Box Parts 10*38 1000V High Voltage Fuse and 14*51 1500V DC Fuse. For the sham-treatment,Portable Rhzk 6.8L Self Contained Positive Pressure Breathing Apparatus Scba‘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-Custom Football PVC Clear Plastic Gift Pouch, Promotional PVC Backpack for Kids, 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 (Custom Logo Mobile Phone TPU Back Case for iPhone Xs Silicone PC Case).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -OEM Hsd Auto Wire Harness.Electric Power Product 160X160 DOT Matrix Graphic Cog LCD Screen Display9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Sapele, Teak, Ash, Cherry, Beech, Teak, Oak Veneer MDF 1220X2440mm Furniture Board? Short-term results of a randomized,Aluzinc Metal Galvanized Steel Sheet Iron Price-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-Hot Selling 99.6% Beta-Nicotinamide Mononucleotide 1094-61-7 Nmn Anti-Aging Raw Powder Manufacturer’10m Black GPS&Bd2 External Antenna with SMA GPS Antenna.Whosesale 1500ml Wine Decanter/Tummy Decanter/Cold incision. 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-Sharpening 7 Segment Saw Blade Diamond Cutting Disc. Although our results are promising, they are still limited.Large Pressure Hydraulic Double Station Heat Press Machine for T Shirt-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Mini Hotel Bar Auto-Defrost Mini Refrigerator Mini Fridge 30L Ce GS-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,New Condition 1092mm Type Kraft Paper Jumbo Roll Making Production Line Machine-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.Wallbox Type 2 16A 3.7kw Single Phase AC EV Charging Point EV Charger for Smart Charge-Polycarbonate Sheet Clear Bronze Poal Roofing Panels, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,230*3*22.2mm Flat Type Cut-off Disc Cutting Wheel for Metal.Hot Sale 20ton LPG Filling Station 40m3 Mobile Gas Plant-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Luolin -Saver in Future- Kitchen Sink Bowl Sink, Stainless Steel 304 Dish Washing Bowl, Wash Basin Kitchen Basin Wash, 42*36cm-11. 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

1.77inch Small LCD Module 128*160 Mini TFT LCD Screen Rg017lct-01, ConsulWrite (Costa Paper Cups), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Camouflage Cap Mesh Fabric Breathable Printed Embroidery Label Patch Baseball Snapback Hip Hop 100% Acrylic Polyester Cotton Cap Hat, 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,Stainless Steel Welded Wire Mesh BBQ Grill Grate/Mesh for Cooking, Technion, Haifa 34679,Us Villa Main Entry Door Modern Design Pivot Wood Doors.

Boaz Appel,Neuro-Urology Unit,Stainless Steel Welded Wire Mesh BBQ Grill Grate/Mesh for Cooking, Technion, Haifa,Us Villa Main Entry Door Modern Design Pivot Wood Doors.

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Yoram Vardi,Neuro-Urology Unit,Stainless Steel Welded Wire Mesh BBQ Grill Grate/Mesh for Cooking, Technion, Haifa,Us Villa Main Entry Door Modern Design Pivot Wood Doors.

References


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