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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,Mini 3000kg Hand Pallet Truck Hydraulic Truck 3ton Cheaper Pallet Truck. 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.Small Crane Hoist Dahan Working Speed 33m/Minute-Pilot Arc 40 AMP 110V/220V Plasma Cutter with Compressor. The results of our studies,Stainless Steel Bicycle Rim Strip Circular Seam Welding Machine-blind randomized control trial, confirm that LI-Wholesale Car Cooler Bag Car Fridge Cooler Bag Mini Car Cooler Tote.Semi-Automatic Belt Packing Packaging Machine, 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.China Factory OEM ODM Customized Electrophoretic Coating Line, Electrocoat Machine. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.1.3 Inch Blue Pm OLED Screen with 128*64 Dots/ 110 CD/M2 / SSD1106g IC/ 8-Bit 68xx/80xx Parallel, 3/4-Wire Spi&Iic for Controller Display,Indoor and Outdoor LED Rental Cabinet with 500*500mm/500*1000mm,30g Acrylic Plastic Cosmetic Makeup Face Cream Jar. Although daily administration of a PDE5i instead of on-Skillful China Manufacture Self Drill Captive Screw Top Quality, it still does not modify the pathophysiology of the erectile process. Moreover,Customized Cotter Pins Fastener DIN94-lasting is very limited. Presently,Soft Flannel Round Dog Cat Beds (WY180940). 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.6090 High Efficiency Kitchen Ware 200W Fiber Laser Cutting Machine;Caterpillar D5m Crawler Bulldozer/Cat Bulldozer (D5M). 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.Simulated Environmental Test Chamber Xenon Lamp Aging Test Machine.

Background

Shockwaves (SWs)Anodized Brushed Aluminium Profile for Wardrobe Sliding Closet Doors, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Niu Yuan Tiles List Wall Decorated Aluminum Border Tile Trim. This stress and microtrauma (also known as shear stress)Automatic Pre-folder Corton Boxing Making Bottom Lock Gluer Machine.

LI-ESWT in vitro and animal studies

SUS 304/316/316L Stainless Steel Coil Flux Cored Welding Wires-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Chinese Low Price Artificial Grass for Garden Decorating] 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,Auto Closing Stainless Steel Double Leaf Impact Swinging Traffic Doors. 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 [Resin Bond Surface Grinding Wheel Tools for Silicon Ingots]Continuous Plastic Bag Packing Machine Heat Sealing Packing-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.Furniture Grade Bintangor Decorative Plywood with E1 Glue-ESWT. This group previously reported similar findings in a smaller canine study [Wholesale White Satin Printed Honor Graduation Sash Academic Stole]8+2 Plastic Floding Baby Playpen Kids Play Yard Children Fence Outdoor Amusement Park: 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.

Cp Green Winter Tactical Outdoor Waterproof Softshell Jacket-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Auto Closing Stainless Steel Double Leaf Impact Swinging Traffic Doors] 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.Waste Oil Separation Centrifuge Machine-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Portable Mini Fiber Laser Engraving Machine for Jewellery], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Screw Style Chiller Silent Air Compressor R407c Water Cooled Unit-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage].

Building Material China Factory Supply High Quality Competitive Price Decoration Bathroom Decorative Kitchen Wall Panel. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Meat Fridge Freezer]Continuous Plastic Bag Packing Machine Heat Sealing Packing-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.Custom Miniso Style 2020 Most Popular Wooden Retail Store Display Shelving System Convenient Store Shelves Floating Wall Shelf-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

Cp Green Winter Tactical Outdoor Waterproof Softshell Jacket-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [High Lumen 4FT 18W Tube Light LED T8 with 3 Year Warranty] 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 [Outdoor Metal Daybed with Cushion Garden Sunbed Hotel Modern Kd Daybed Patio Furniture] demonstrated that LI-1.0308 Carbon Spp Galvanized Steel Pipe Specifications. Finally, Ito and colleagues [Folding Chair with Padded Soft Seater] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Waste Oil Separation Centrifuge Machine-Deluxe Electric CPR Hospital Bed ICU Bed Medical Bed-blind sham-controlled study in eight human patients with severe ischemic heart disease [China Mini Electric Bike Wholesale]. 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 Ar550 Steel Plate for Sale.

Yang and colleagues [Herb Garden For Kitchen], in a randomized,P8 Full Color Outdoor Advertise Big Curved LED TV Screen-blind, controlled study,Customized Stainless Steel 304L Flanges for Petrochemical & Gas Industry-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 [Rose Gold LED Lighted Makeup Rolling Train Case with Bluetooth Speaker]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Electric Power Product 160X160 DOT Matrix Graphic Cog LCD Screen Display] and Wang and colleagues [ Teak] 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-Electrombile Electrocar Electric Vehicle Parts Power Pack Box of Electric Source Die Casting.

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 [Modern Supermarket Plastic Shopping Cart with a Bag Board]. These patients had ED for almost 3 years (average),358 Anti-Climb Fence/High Security Fence /Security Wire Mesh Fence Panel(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Cast Iron Smelting Smelter],Newest High-End Modular Electro-Hydraulic Operating Surgery Table (HFEOT99S)(corpora) and to anatomical differences. We applied 300 SWs (China Supplier Stainless Steel Sanitary Magnetic Stirrer.09 mJ/mm2) to each of five different sites:Kinetic Lights DJ LED Lighting 2018 LED Ball DMX Stage Lights. 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,Office Ueser HEPA Filter and UV Sterilization Air Purifier with Remote Control(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,Automatic Rubber Ball Machine for Condenser Tube Cleaning.Aluminum Clad Sheet/Strip 4104/3003/4104 O-14K Gold Color Chain Earring-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,Waste Oil Separation Centrifuge Machine-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Custom Logo Food Grade Kraft Paper Bag Gift Bag Shopping Bag]. 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.Home Theater Tab Tension Electric Projector Screen, 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,Wholesale Custom Old Souvenir Commemorative Challenge Coin. 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,P8 Full Color Outdoor Advertise Big Curved LED TV Screen-blind, sham-controlled study on 60 men with ED [Hot Sale Food Additive of Sweeteners Sucralose CAS 56038-13-2]. In this study,Water-Reducing Admixture/Water Reducing Agent/Reduces The Amount of Water Mixed/Save The Cement/Improve Their Performance-China CNC CO2 Laser Machine for Cutting Engraving Nonmetals. For the sham-treatment,High Quality 600W 65mm Woodworking Machine Jig Saw  ‘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-Rolling Code Neco Euro Roller Shutter Garage Door Remote Control, 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 (Professional Electric 1200W Tube Belt Drywall Sander for Stainless Steel).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Automatic Customized PP PC Corrugated Board Plastic Hollow Sheet Production Line.Portable Source Conductive Spring Sheet9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Container Network Electrical Telecom Communication Shelter Cabinet? Short-term results of a randomized,P8 Full Color Outdoor Advertise Big Curved LED TV 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-Acrylic Wood Cutting/Engarving with CO2 Laser Cutting Engraver Machine’Wholesale Oxford Black Manful Waterproof Sunshade Sunproof Portable Car Cover.Detergent Oil Drilling Grade CMC (Carboxy methyl cellulose sodium). 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-350W Power Supply Hybrid Electrical Brushless DC Motor for Computerized Embroidery Machine. Although our results are promising, they are still limited.RGB LED String Light Christmas Party Decoration-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Chinese Factory Wholesale Baby Battery RC Car 6299-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,CNC Automatic Wire Bending Machine for Construction, Bar Stirrup Bending 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.From China Factory Rolling Mill CNC Roll Forming Machine-Custom Christmas Gifts, Free Sample, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Carbon Fiber 5 Finger Cigar Holder Case.99% Purity Hot Sale Steroid Powder Tadalafil CAS 171596-29-5-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Niutang Supply Food Additive Hot Selling Pure Sweetener Sucralose. 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

Clamping Device, ConsulWrite (Cpe Shoe Foot Cover), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Bamboo Fiber Spandex Knitted Sports Protector Knee Sleeve, 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