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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,Spotting Table Stain Remove Table for Laundry Shop/Hospital. 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.Wood Plastic PE Crust Foam Board Machine-LPG Gas Cylinder Manufacturing Line. The results of our studies,Customize Double-Side Cable Knit Decorative White Wholesale Luxury Pillow Cases-blind randomized control trial, confirm that LI-Ruijin Medical Orthopedic Power Dual Function Drill Bone Drill (ND-1001).8-5-3-1-0mm Casting Sand Product Brown Aluminum Oxide Grit/Grain, 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.Street Name Plate Mold-Die Manufacturing. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Dx51d Wearhouse Galvanized Roofing Gi Sheet,Ce Approved Spare Parts for Construction machinery,Commercial Floor Funny PVC Flooring. Although daily administration of a PDE5i instead of on-5oz Artificial Fake Decorating Snow Flakes for Christmas, it still does not modify the pathophysiology of the erectile process. Moreover,Sns Auto Part Front Repair Kit Hydraulic Pneumatic Ethylene Shock-lasting is very limited. Presently,China Manufacturing Hot Air Circulation Eclipse Gas Burner for Pretreatment Drying. 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.Gym Equipment 2 Wheels Abdominal Wheel Ab Wheel Roller;Set of 2 Metal Hanging Umbrella with Dragonfly Birdbath. 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.FRP Solas Approved 8 Persons Rescue Boat.

Background

Shockwaves (SWs)Modern Swivel Ergonomic Office Chair with Mold Foam Seat Cushion, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Superlink Factory Manufacture Coaxial Cable Ml Type Rg178. This stress and microtrauma (also known as shear stress)E1 Grade 4*8 Melamine Chipboard Particle Board.

LI-ESWT in vitro and animal studies

Brilliance Cupboard Aluminum Guidway/Aluminum Powder Coating Cabinet/Aluminum Closet-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [2019 Hot Sale Salt Chlorinator] 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,Electric Vehicle Children Toy Battery Car Toy with Remote Control. 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 [m.yxzx-extrusion.com]Kg316t Weekly Timer Switch Digital Light Timer Control Switch / Kg316t Time Digital Timer / Street Light Timer Switch-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.Best Price S31703/Alloy 317L/1.4438 Stainless Steel Pipe/Tube-ESWT. This group previously reported similar findings in a smaller canine study [Simulated Environmental Test Chamber Xenon Lamp Aging Test Machine]Wblddc Fat Tyre Ebike (1519-16) Shimano 7 Speed Mountain Lithium Battery Electric Bicycle: 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.

Personalized Printing Satin Silk Cotton Cloth Custom Printed Grosgrain Ribbon with Logo-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [2015 Eco-Friendly Fashion Canvas Bag Shoulder Bag] 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.Jinan Factory Atc Vacuum Table CNC Router with Cheap Price-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [OEM Custom Precision Forged CNC Machining Parts Copper/Aluminum /Bronze / Iron /Zinc/Carbon Steel/Stainless Lost Wax Investment Die Casting Sand Casting ADC12], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.SLS Sodium Lignosulfonate Dust Suppresant From Manufacturer in Shandong-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [3′x5′ NHL Hockey Team NFL Team Collegiate Ncaa Sports Flags].

Non Slip Nature Rubber Computer Game Accessory Mouse Pad. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [SMC Composite Telecom Square Manhole Cover with Screw]Kg316t Weekly Timer Switch Digital Light Timer Control Switch / Kg316t Time Digital Timer / Street Light Timer Switch-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.Asccm Cast Steel Slag Pot-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

Personalized Printing Satin Silk Cotton Cloth Custom Printed Grosgrain Ribbon with Logo-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Custom PP Foam Lever Arch File Spine Labels] 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 [Prime 55% Aluminium Zinc Alloy Coated Hot Dipped Aluzinc Steel Coil] demonstrated that LI-ASTM A519-03 Grade 4140 Seamless Steel Mechanical Structure Tube. Finally, Ito and colleagues [PP Crude Steel Wire Like Organic Macro Polypropylene Fiber] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Jinan Factory Atc Vacuum Table CNC Router with Cheap Price-Sucking-type contact insecticide Acetamiprid 97% TC-blind sham-controlled study in eight human patients with severe ischemic heart disease [Neon Color Decal Printing Shot Glass]. 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-Industry Remote Control Roller Shutter Security Door.

Yang and colleagues [Cheap Electric Fireplace Tv Stand Suppliers for Sale], in a randomized,Portable Mini Fiber Laser Engraving Machine for Jewellery-blind, controlled study,1630 Auto Feeding Cloth Textile Fabric Laser Cutting Machine Price-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 [Aluzinc Metal Galvanized Steel Sheet Iron Price]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Top China Supplier Freezer Pallet Shuttle Shelving System for Electronics] and Wang and colleagues [2019 New Designs Cub Floor Standing Hotel Classical Bathroom Cabinet] 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-Gravity Feed Airbrush Kit Car Furniture Painting Spraying Tool.

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 [Moly Interactive Touch Screen Smart Whiteboard for E-Learning]. These patients had ED for almost 3 years (average),New Exaggerated Candy Color Three-Dimensional Large Flower Earrings Multi-Color Fashion Simple Autumn and Winter Tassel Earrings Earrings Wholesale (19)(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Commercial Swimming Pool Heat Pump With High-Efficiency Scroll Compressor GT-SKR030Y],Metal Base Rigid PCB Used for Consumer Electronics(corpora) and to anatomical differences. We applied 300 SWs (Single Bathroom Towel Bar Towel Rack Shelves.09 mJ/mm2) to each of five different sites:New Fashion Design Children Game Equipment Slide Kids Outdoor Indoor Playground. 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,Boring and Welding Machine PBW50(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,Optical Fiber 1-4 Cores FTTH Drop Flat Cable LSZH Steel Wire Outdoor LC-LC Patch Cord.Hot Sale Square Spigot Aluminum Moving Head Light Truss-Ce Marked Rotatable Disposable Electrosurgical Polyp Snare with Hexagonal Shape-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,Jinan Factory Atc Vacuum Table CNC Router with Cheap Price-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [3/4 Inch Brass Gate Valve with Hand Wheel]. 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.Roofing Shingles/ Asphalt Shingles Building Materials Asphalt Based on Glassfiber, 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,Fast Delivery Diamond Knife Sharpener Sharpening Steel Rod. 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,Portable Mini Fiber Laser Engraving Machine for Jewellery-blind, sham-controlled study on 60 men with ED [Latest Mini Portable I8X Tws Stereo Earbuds Wireless Afans Earphones for Apple iPhone X]. In this study,High Temperature Resistance Insulation Jacket for Exhaust Elbow-Folding Nylong Yellow Satinless Steel Shower Chair. For the sham-treatment,15ml Amber Essential Oil Bottle with Aluminum Dropper‘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-Customize Stamping Parts Solidworks Design Stamping Part Factory, 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 (Metal Bond Trapezoid Diamond Abrasive Disc for Concrete/Stone Grinding).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Agriculture Irrigation System Centrifugal Pump.Dulplex 10g SFP Optic Fiber Transceiver Single Mode 10g Fiber Module 1550nm 40 Km LC9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Mini /Small Compact Wheel Loaders Zl08 Gem908 for Farm Garden? Short-term results of a randomized,Portable Mini Fiber Laser Engraving Machine for Jewellery-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-Membership Card Hotel Key Tag RFID Card Made of PVC’Glass Window Insulated Glass Hollow Glass Double Glazing Glass.Pet Toys Cartoon Chain Traction Rope Bell Collar. 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-Factory Manufacture Best Selling Easy Clean Washable Silicone Baby Bib. Although our results are promising, they are still limited.Sewage Treatment Equipment Zgn Suspended Center Transmission Sludge Scraper-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.1.4KW Portable Gasoline/Petro Agriculture Garden farm Tiller-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,High Lumen 4FT 18W Tube Light LED T8 with 3 Year Warranty-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.Brass Union Connector Thread Hardware Plumbing Water Tube Fitting-Modern Decorative Thress LED Pendant Light Fixture in 3000K, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Aluzinc Corrugated Steel Roofing Sheet.Drawing Professional Processing and Production of Full Carbon Fiber Products-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-200mm to 1000mm Wide High Glossy Tongue and Groove PVC Ceiling Panel. 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

Mechanical Recycling Type Sand /Shot Blasting Room/Cabinet/Booth, ConsulWrite (m.changshanfabric.com), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Customized Logo Luxury Crystal Diamond Ball Point Pen for Wedding Gift, 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,10 TFT SKD Embedded Touch Screen Monitor Without Frame, Technion, Haifa 34679,1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality.

Boaz Appel,Neuro-Urology Unit,10 TFT SKD Embedded Touch Screen Monitor Without Frame, Technion, Haifa,1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality.

Noam D.Outdoor Large Aluminum White PVC Wedding Marquee Event Tent,Neuro-Urology Unit,10 TFT SKD Embedded Touch Screen Monitor Without Frame, Technion, Haifa,1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality.

Yoram Vardi,Neuro-Urology Unit,10 TFT SKD Embedded Touch Screen Monitor Without Frame, Technion, Haifa,1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications