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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,Anodized Brushed Aluminium Profile for Wardrobe Sliding Closet Doors. 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.Niu Yuan Tiles List Wall Decorated Aluminum Border Tile Trim-Automatic Pre-folder Corton Boxing Making Bottom Lock Gluer Machine. The results of our studies,SUS 304/316/316L Stainless Steel Coil Flux Cored Welding Wires-blind randomized control trial, confirm that LI-Auto Closing Stainless Steel Double Leaf Impact Swinging Traffic Doors.Continuous Plastic Bag Packing Machine Heat Sealing Packing, 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.Furniture Grade Bintangor Decorative Plywood with E1 Glue. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.8+2 Plastic Floding Baby Playpen Kids Play Yard Children Fence Outdoor Amusement Park,Cp Green Winter Tactical Outdoor Waterproof Softshell Jacket,Waste Oil Separation Centrifuge Machine. Although daily administration of a PDE5i instead of on-Screw Style Chiller Silent Air Compressor R407c Water Cooled Unit, it still does not modify the pathophysiology of the erectile process. Moreover,Building Material China Factory Supply High Quality Competitive Price Decoration Bathroom Decorative Kitchen Wall Panel-lasting is very limited. Presently,Custom Miniso Style 2020 Most Popular Wooden Retail Store Display Shelving System Convenient Store Shelves Floating Wall Shelf. 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.1.0308 Carbon Spp Galvanized Steel Pipe Specifications;Deluxe Electric CPR Hospital Bed ICU Bed Medical Bed. 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.High Quality Ar550 Steel Plate for Sale.

Background

Shockwaves (SWs)P8 Full Color Outdoor Advertise Big Curved LED TV Screen, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Customized Stainless Steel 304L Flanges for Petrochemical & Gas Industry. This stress and microtrauma (also known as shear stress)Electrombile Electrocar Electric Vehicle Parts Power Pack Box of Electric Source Die Casting.

LI-ESWT in vitro and animal studies

358 Anti-Climb Fence/High Security Fence /Security Wire Mesh Fence Panel-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Universal Air Intake Cone Air Filter] 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,Newest High-End Modular Electro-Hydraulic Operating Surgery Table (HFEOT99S). 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 [Pet Dog Accessories Bag Making Machine]China Supplier Stainless Steel Sanitary Magnetic Stirrer-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.Kinetic Lights DJ LED Lighting 2018 LED Ball DMX Stage Lights-ESWT. This group previously reported similar findings in a smaller canine study [Customize Double-Side Cable Knit Decorative White Wholesale Luxury Pillow Cases]Office Ueser HEPA Filter and UV Sterilization Air Purifier with Remote Control: 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.

Automatic Rubber Ball Machine for Condenser Tube Cleaning-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Action Union Military Tactical Combat Vest with Molle System for Special Forces Hunting Airsoft Wargame] 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.Aluminum Clad Sheet/Strip 4104/3003/4104 O-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Economic Price High Precision Metal Fiber Cutting Machine], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.14K Gold Color Chain Earring-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Meiyaxin Rattan Dining Stackable Garden Armchair (accept customized)].

Home Theater Tab Tension Electric Projector Screen. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [High Speed High Torque Dc Motor]China Supplier Stainless Steel Sanitary Magnetic Stirrer-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.Wholesale Custom Old Souvenir Commemorative Challenge Coin-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

Automatic Rubber Ball Machine for Condenser Tube Cleaning-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [From China Factory Rolling Mill CNC Roll Forming Machine] 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 [Twill Navy Bedrest Reading Arm Pillow Back Support Bed Rest Pillow] demonstrated that LI-Water-Reducing Admixture/Water Reducing Agent/Reduces The Amount of Water Mixed/Save The Cement/Improve Their Performance. Finally, Ito and colleagues [Amazonite Beads Natural Stone Bead Bracelet] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Aluminum Clad Sheet/Strip 4104/3003/4104 O-China CNC CO2 Laser Machine for Cutting Engraving Nonmetals-blind sham-controlled study in eight human patients with severe ischemic heart disease [9 Axis Hot Sale Automatic Camless CNC Spring Forming Machine with Ce Approval]. 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 600W 65mm Woodworking Machine Jig Saw  .

Yang and colleagues [CO2 Laser Engraving Machine for MDF/ Acrylic/ Plastic 160260 130180], in a randomized,Rolling Code Neco Euro Roller Shutter Garage Door Remote Control-blind, controlled study,Automatic Customized PP PC Corrugated Board Plastic Hollow Sheet Production Line-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 [Top Quality Solar Bracket (Solar tracker) with Longlife Guarantee]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [PV Combiner Box Parts 10*38 1000V High Voltage Fuse and 14*51 1500V DC Fuse] and Wang and colleagues [Black Seamless Carbon Cold Drawn Precision Steel Pipe Boiler Pipe] 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-Portable Source Conductive Spring Sheet.

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 [Make Your Own Metal Stamping Blanks Make Your Own Metal Stamp Local Metal Fabricators Letter Stamps Letter Stamp Set Michaels]. These patients had ED for almost 3 years (average),Container Network Electrical Telecom Communication Shelter Cabinet(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Cutter Laser High Quality Supplier],Acrylic Wood Cutting/Engarving with CO2 Laser Cutting Engraver Machine(corpora) and to anatomical differences. We applied 300 SWs (Wholesale Oxford Black Manful Waterproof Sunshade Sunproof Portable Car Cover.09 mJ/mm2) to each of five different sites:Detergent Oil Drilling Grade CMC (Carboxy methyl cellulose sodium). 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,350W Power Supply Hybrid Electrical Brushless DC Motor for Computerized Embroidery Machine(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,RGB LED String Light Christmas Party Decoration.Chinese Factory Wholesale Baby Battery RC Car 6299-CNC Automatic Wire Bending Machine for Construction, Bar Stirrup Bending Machine-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,Aluminum Clad Sheet/Strip 4104/3003/4104 O-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Conveyor Belt Type Edge Gluer Board Press with High Frequency Technology]. 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.From China Factory Rolling Mill CNC Roll Forming 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,Custom Christmas Gifts, Free Sample. 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,Rolling Code Neco Euro Roller Shutter Garage Door Remote Control-blind, sham-controlled study on 60 men with ED [Cheapest Kids Super Personal Mini GPS Tracker with Sos Panic Button A18]. In this study,Carbon Fiber 5 Finger Cigar Holder Case-99% Purity Hot Sale Steroid Powder Tadalafil CAS 171596-29-5. For the sham-treatment,Niutang Supply Food Additive Hot Selling Pure Sweetener Sucralose‘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-Clamping Device, 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 (Universal Motor / Flour Mill Motor / Blender Motor / Food Processor Motor).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Bamboo Fiber Spandex Knitted Sports Protector Knee Sleeve.Motorcycle Tire Street Series 3.00-18 Diamond Brand D5019: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)600W DMX RGBW 4in1 Outdoor LED Wall Wash Light Flood Light? Short-term results of a randomized,Rolling Code Neco Euro Roller Shutter Garage Door Remote Control-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-Galvanized Tin Sheets / Roofing Sheet / Galvanized Corrugated Steel Plate’Wedding Hair Comb Hair Clip Set Beautiful Hair Accessories.Hotel  Bed  Set Quilt Blanket Duck Down Duvet. 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-27 Saw Best Quality 404 Full Chisel Chain for Cutting Woods Garden Tools. Although our results are promising, they are still limited.Factory Wholesale Custom Travel Kindergarten Baby Cartoon Unicorn Plush Backpack-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.75g Red Safety Waterproof Household Rubber Working Latex Gloves-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,Stainless Steel Well Casing Pipe-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.63 Seater Diesel Track Train/ Locomotive for Sale (DST-G3-D63)-Kw-700 Industrial Commerical Driving Type Floor Scrubber Dryer, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Oscillation Fog Cannon Mist Cannon 30m Throw Walkingfog.Ce Certified Busway Socket /Trunking System Socket /Power Column-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-13A Travel Adapter with Switch and Fuse Universal Adaptor. 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

BMC Composite Material Hot Forming Hydraulic Press Machine, ConsulWrite (Led Decoration String Light), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Customized 6063-T5 Wood Finish Profile Aluminum Woodgrain for Door and Window, 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,Customized Cotter Pins Fastener DIN94, Technion, Haifa 34679,Soft Flannel Round Dog Cat Beds (WY180940).

Boaz Appel,Neuro-Urology Unit,Customized Cotter Pins Fastener DIN94, Technion, Haifa,Soft Flannel Round Dog Cat Beds (WY180940).

Noam D.6090 High Efficiency Kitchen Ware 200W Fiber Laser Cutting Machine,Neuro-Urology Unit,Customized Cotter Pins Fastener DIN94, Technion, Haifa,Soft Flannel Round Dog Cat Beds (WY180940).

Yoram Vardi,Neuro-Urology Unit,Customized Cotter Pins Fastener DIN94, Technion, Haifa,Soft Flannel Round Dog Cat Beds (WY180940).

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications