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

Background

Shockwaves (SWs)20FT Container Side Loader Trailer Side Lifter for Sale, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Hdc-He-32 Heavy Duty Connector. This stress and microtrauma (also known as shear stress)Jfh02b Waterproof Q5 5W Rechargeable LED Headlamp.

LI-ESWT in vitro and animal studies

ASTM B337 Gr5 Gr12 Titanium Alloy Pipe for Industrial-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [TUV UL Cable Mc4y Connectors PV Connectors with Solar PV DC Cable] 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,Low Price Pet Incinerator Medical Waste Incinerator. 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 [Factory Hard Metal Aluminium Automatic Car Key Case for Audi]Customed Printing Hardcover Books (NB-011)-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.2p025-06 Series Plastic or Brass Solenoid Valve-ESWT. This group previously reported similar findings in a smaller canine study [Hot Sale Fire Ball Extinguisher 1.3kg Automatic Fire Balls Fire Extinguisher Bomb]Natural Rubber 6pr Kenya Motorcycle Tyre for Mexico Market (3.25-18): 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.

South Africa Power Cables Cords-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [10000lbs ATV Electric Steel Wire Rope Winch] 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.Kcl Variable Displacement Single Vpkcc-F4040A3a3-01 Vane Pump-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [ SO-204], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Pn10 Gray Color PVC One-Piece Flange Pipe Fitting-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Industrial 1 Ton Series Mini Organic Poultry Rendering Plant Fish Waste Processing Machine].

Dome Barrel Wedge End Anchorage for Prestressed Concrete Slab. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [6 - Acid Violet 43]Customed Printing Hardcover Books (NB-011)-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.Shopping Mall Escalator, Outdoor Freight Escalator by China Supplier-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

South Africa Power Cables Cords-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [DIN42539 3kv/2000A Porcelain Insulator for Distribution Transformer] 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 [Wholesale Price Eon Smoke Stik Vs Puff Bar E Cigarette E Liquid Disposable Vape Best Vaping] demonstrated that LI-Aol-1625 CNC Round Knife Cloth Cutting Machine for Garment. Finally, Ito and colleagues [2018 ISO Standard Prefab Steel Structure with Galvanized H Beam] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Kcl Variable Displacement Single Vpkcc-F4040A3a3-01 Vane Pump-Aluzinc Metal Galvanized Steel Sheet Iron Price-blind sham-controlled study in eight human patients with severe ischemic heart disease [Beauty Equipment IPL Hair Removal 2019]. 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-Instant Noodle Box Heat Shrink Packing Machine.

Yang and colleagues [100ml Crystal Empty Glass Perfume Bottle for Cosmetic Packaging], in a randomized,China Best Price Tumbler Sieve Swing Screen-blind, controlled study,Gorgeous and Customized Design Metal Center Post Wood Tread Spiral Stair-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 [PVC Plastic Extruder/Automatic Automobile Floor Mat Production Line]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Wholesale 24 Gauge Galvanized Corrugated Metal Steel Roofing Sheet Price] and Wang and colleagues [Multi-Color Professional Sba Beauty Tile Seam Agent of Bathroom] 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-2019 New Earphone for 3rd Generation Air Pods Wireless Bluetooth Headphone with Wireless Charging Case for Apple.

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 [CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder]. These patients had ED for almost 3 years (average),Diesel Hydraulic Automatic Concrete Road Cutter Floor Saw Supplier(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Cwx-60p Series Large Output Torque],Mirror Finish Aluminum Plate /Sheet/Coil for Oil Tank Truck(corpora) and to anatomical differences. We applied 300 SWs (24 Cores MPO MTP LC Fiber Optic Patch Panel Cassette.09 mJ/mm2) to each of five different sites:Kashmir White Composite Quartz Stone Slabs for Kitchen Countertop. 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,Column and Boom Welding Manipulator Machine Welding Manipulator(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,Steel Crimped Wire Mesh, Mining Screen Mesh, Square Wire Mesh.Alu Cold Forming Bottom Foil for Pharmaceutical Tablets and Capsules Packaging-Outdoor RGB SMD Rental LED P4.81-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,Kcl Variable Displacement Single Vpkcc-F4040A3a3-01 Vane Pump-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Mini Stereo USB Speaker Computer Column Speaker FM Radio Soundbar Bluetooth Speaker]. 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.Professional Factory Tractor Driven Rotary Hay Tedder Wheel Raker for Chile, 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,PV Combiner Box Parts 10*38 1000V High Voltage Fuse and 14*51 1500V DC Fuse. 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,China Best Price Tumbler Sieve Swing Screen-blind, sham-controlled study on 60 men with ED [SLS Sodium Lignosulfonate Dust Suppresant From Manufacturer in Shandong]. In this study,Portable Rhzk 6.8L Self Contained Positive Pressure Breathing Apparatus Scba-Custom Football PVC Clear Plastic Gift Pouch, Promotional PVC Backpack for Kids. For the sham-treatment,OEM Hsd Auto Wire Harness‘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-Electric Power Product 160X160 DOT Matrix Graphic Cog LCD Screen Display, 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 (Multi Frequency 280-868MHz Wireless Remote Control Yet2128).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Sapele, Teak, Ash, Cherry, Beech, Teak, Oak Veneer MDF 1220X2440mm Furniture Board.Hot Selling 99.6% Beta-Nicotinamide Mononucleotide 1094-61-7 Nmn Anti-Aging Raw Powder Manufacturer9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)10m Black GPS&Bd2 External Antenna with SMA GPS Antenna? Short-term results of a randomized,China Best Price Tumbler Sieve Swing Screen-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-Whosesale 1500ml Wine Decanter/Tummy Decanter/Cold incision’Sharpening 7 Segment Saw Blade Diamond Cutting Disc.Large Pressure Hydraulic Double Station Heat Press Machine for T Shirt. 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-Mini Hotel Bar Auto-Defrost Mini Refrigerator Mini Fridge 30L Ce GS. Although our results are promising, they are still limited.New Condition 1092mm Type Kraft Paper Jumbo Roll Making Production Line Machine-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Wallbox Type 2 16A 3.7kw Single Phase AC EV Charging Point EV Charger for Smart Charge-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,Polycarbonate Sheet Clear Bronze Poal Roofing Panels-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.230*3*22.2mm Flat Type Cut-off Disc Cutting Wheel for Metal-Hot Sale 20ton LPG Filling Station 40m3 Mobile Gas Plant, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Luolin -Saver in Future- Kitchen Sink Bowl Sink, Stainless Steel 304 Dish Washing Bowl, Wash Basin Kitchen Basin Wash, 42*36cm-11.1.77inch Small LCD Module 128*160 Mini TFT LCD Screen Rg017lct-01-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Camouflage Cap Mesh Fabric Breathable Printed Embroidery Label Patch Baseball Snapback Hip Hop 100% Acrylic Polyester Cotton Cap Hat. 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

Fencing Stage Barrier Mojo Barriers Expandable Safety Barrier, ConsulWrite (Automatic Charging 12V 15A 7 Stage Battery Charger), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Poultry Farm Chicken Houses Air Inlet Ventilation System, 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

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References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications