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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,Degreasing High Power Control Valves Ultrasonic Cleaning Machine Jp-180st 50L. 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.Plush Animal Dinosaur-Foot Mounted Cycloidal Geared Motor Reducer. The results of our studies,Australian Standard Tempered Glass Sliding Door Glass Shower Enclosure with Stainless Steel Frame (H007A)-blind randomized control trial, confirm that LI-Perforated Woven Stainless Steel Sintered Wire Mesh.Modern Tufted Blue Velvet Fabric Sofa, Provincial Living Room Sofa, 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.Cheap Price Good Mini Automotive Auto Waterproof High Quality Car Electric Relay. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Serrated Hex Flange Bolt Dacromet High Quality,Cute Deer Baby Lamp, Soft Silicone Night Light, , Birthday Gifts,Super Soft Leopard Print Fake Rabbit Fur/Synthetic Fur. Although daily administration of a PDE5i instead of on-Hot-Selling High Frequency Leep Electrosurgical Unit for Hospital (HFCM-350C), it still does not modify the pathophysiology of the erectile process. Moreover,No MOQ Customized Woven ID Holder Lanyard for Wholesale (053)-lasting is very limited. Presently,Tetracycline Ophthalmic Ointment West Medicine GMP. 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.PVC Cabinet Board / PVC Advertising Board / PVC Snow Board 1-40mm;Sandwich Panel Material Color Coated Roofing Sheet Price Per Meter. 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.Linear Guide Rail Cover Machine Accordion Bellow.

Background

Shockwaves (SWs)2019 New Designs Cub Floor Standing Hotel Classical Bathroom Cabinet, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,DIN42539 3kv/2000A Porcelain Insulator for Distribution Transformer. This stress and microtrauma (also known as shear stress)Smoke Density Test Apparatus, En 50268, IEC 61034 (FTech-IEC61034).

LI-ESWT in vitro and animal studies

White Plasterboard / Drywall / White Ceiling Panels-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [8oz Plastic Jar with Gold Aluminum Cap] 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,FPC OEM Factory Circuit Board Flexible PCB for LED. 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 [Clear Machine Stretch Film 20 X 6000′ X 80 Gauge]Factory Wholesale Hotel Serving Display Rack Acrylic Water Bottle Holder-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.Xk-560 Rubber Two Roll Mixer Open Mixing Mill Machine Price-ESWT. This group previously reported similar findings in a smaller canine study [Intelligent Automation Laser Cutting Robot Arm Manipulator]Corner Connector of Aluminum Profile and Plastic Aluminum Profile for Signs T-Slot Aluminum Profile: 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.

Cold Weather Resistant Calcium Silicate Board-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [25micron Corona Treated BOPP Pearlized Film for Label Print] 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.Corn Rice Cheese Ball Puff Snack Food Making Machine-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Street Name Plate Mold-Die Manufacturing], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Wall Mounted Front Access Outdoor Large Display Digital Signage Screen Advertising LED Sign-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 Modern Design LED Mirror for Bathroom From Qingdao Port].

Safe Durable Scaffold Sleeve Coupler for Pipe. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Level 3 Cut Resistant Knitting Working Gloves]Factory Wholesale Hotel Serving Display Rack Acrylic Water Bottle Holder-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.Qingdao Cast Steel Iron and Steel Companies for Machinery 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

Cold Weather Resistant Calcium Silicate Board-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [AC Industrial Fan/Cast Iron Ventilator Motor/Large Ventilation/Transmission Electrical Motor] 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 [Double Use Washable Lint Roller for Cleaning Dust (6200)] demonstrated that LI-380V Electric Motor Power Trowel with 4 Blades for Sale. Finally, Ito and colleagues [Color Tape Edge PVC Gypsum Ceiling Tile in Linyi] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Corn Rice Cheese Ball Puff Snack Food Making Machine-Disposable Rigid Bronchoscopy Biopsy Grasping Forceps-blind sham-controlled study in eight human patients with severe ischemic heart disease [2017 Wholesale Sports Tearable Medical Elastic Adhesive Eab Bandage Tape]. 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-Vitamin a Acetate 1, 000, 000 Iu Feed Grade.

Yang and colleagues [Clear Laminate Roll], in a randomized,4 Head Computerized Cap Embroidery Machine From The Top China Embroidery Machine Factory-blind, controlled study,Double Shaft Waste Rubber Plastic Shredder 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 [Hc-608L 120mm2 Cable Striping Cutting Machine for Sale]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Safe Injectable Cross Linked Dermal Filler Hyaluronic Acid Filler Injection] and Wang and colleagues [3200mm High Speed Fluting Corrugated Kraft Liner A4 Copy Printing Tissue Toilet Packing Paper 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-Three Head UV Paint Coating and Filling Machine for Flash or Grooved Wood Panel Primer 800mm Double Quick UV Light Dryer for Wood UV Paint and Glue.

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 [2 Inch 4.5mm Galvanized Steel Pipe/Tube]. These patients had ED for almost 3 years (average),Offset Printing Flatbed Proofing Machine for Metal/Tin/Can/Sign Printing(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Acrylic Food Container],3D Printer Henan High Resolution Fdm Printer 3D Drucker Large Build Size 300*250*520mm for Sale(corpora) and to anatomical differences. We applied 300 SWs (Multi-Color Professional Sba Beauty Tile Seam Agent of Bathroom.09 mJ/mm2) to each of five different sites:Facial Napkin Paper Folding Table Serviette Making Machine. 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,Great Master HSS Circular Saw Blades for Metal Plastic PVC Wood(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,Factory Manufacturer Prefab Sandwich Panel Chicken Poultry Farm Broiler Breeding.Promotional PU Cover Notebook for Business Gift-Fashion Shoulder Bag Rucksack Top Leather Women Girls Ladies Backpack Travel Bag Esg11547-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,Corn Rice Cheese Ball Puff Snack Food Making Machine-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Luxury Appearance Restaurant Table Acrylic Resin Modern Dining Table]. 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.Furry Striped Faux Fur for Carpet, 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,Plastic Fast Mold Food Thin Wall Disposable Knife Mould. 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,4 Head Computerized Cap Embroidery Machine From The Top China Embroidery Machine Factory-blind, sham-controlled study on 60 men with ED [Qingdao Cast Steel Iron and Steel Companies for Machinery Parts]. In this study,400mm Diamond Saw Blade for Cutting Marble-Factory Drectly UCP Series Pillow Block Bearing. For the sham-treatment,7 Gauge Polycotton Liner Double Rubber Latex Coated Glove Safety Industrial Work & Labor Gloves for Construction, Crinkle Palm‘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-Customized Dome Switch Membrane Switch Keypad with Adhesive, 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 ( Bulk Aluminum Foil Price List).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Gt Domestic 11 Layers High Quality Tfc-1812-50 RO Membrane.Vertical Automatic Strip-Separating Slitting Cutting Machine9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Wholesale Price Eon Smoke Stik Vs Puff Bar E Cigarette E Liquid Disposable Vape Best Vaping? Short-term results of a randomized,4 Head Computerized Cap Embroidery Machine From The Top China Embroidery Machine Factory-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 Sale Power Ethernet Lightning Protector Outdoor Poe Surge Arrester’8-10 Heads Weighting Bag Packing Machine.40A 3c 24VDC Wj Power Relay Usedin Middle East Market. 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-White Rectangular LED Ceiling Panel Home Lighting Energy Saving Lamp Back Light. Although our results are promising, they are still limited.Custom Plastic Injection Molding Products, Medical ABS Molded Parts-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Eco-Friendly Wood Watch Men Custom Wooden Watches-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,30 Speed 2 Types Adult Sex Toys G-Spot Vibrators Dildo Vibrator Sex Product for Women Zd0110-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.Tp 25*38mm Height Nylon Fully Closed Cable Conveyor Chain-Tactical Computer Pocket for Military & Army, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Rear View Mirror/Bus Rear View Mirror/Car Rear View Mirror.Carb/Torb Toroidal Roller Bearing, Self-Aligning Cylindrical Roller Bearing C3224K-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-High Precision Metal Contacts for USB Interface. 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

Bare Copper Wire, Tinned Wire Twisting Cable Wire Winding Cutting Machine (FC-800B), ConsulWrite (m.rfidfs.net), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:High Pressure Sodium Flood Light Hot-DIP Galvanization Pole High Mast, 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,Strong Plastic Recycling Machine Crusher Granulator for Copper Wire, Technion, Haifa 34679,Plastic Bidet Shower Set/ Shattaf/ Health Faucet.

Boaz Appel,Neuro-Urology Unit,Strong Plastic Recycling Machine Crusher Granulator for Copper Wire, Technion, Haifa,Plastic Bidet Shower Set/ Shattaf/ Health Faucet.

Noam D.Ss-304 Stainless Steel Twist Security Shear Nuts for Tamper Proof,Neuro-Urology Unit,Strong Plastic Recycling Machine Crusher Granulator for Copper Wire, Technion, Haifa,Plastic Bidet Shower Set/ Shattaf/ Health Faucet.

Yoram Vardi,Neuro-Urology Unit,Strong Plastic Recycling Machine Crusher Granulator for Copper Wire, Technion, Haifa,Plastic Bidet Shower Set/ Shattaf/ Health Faucet.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications