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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,Smart Drug Nootropics Powder Fasoracetam Aka Ns-105 for Enhancing Memory. 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.Agricultrue Farming Spade Shovel Head for Digger-Tecjet S 1671 Dx7 Industrial Heavy Duty Tarpaulin Roland Printer Flex Banner Printing Machine. The results of our studies,FTTH 12 Cores Pigtail PLC Splitter Fiber Optic Splice Box/Otb/Termination Box-blind randomized control trial, confirm that LI-Factory Granular Packing Snack Foods Beans Seeds Rice Sugar Salt Grain Packaging Machine.New Design Stainless Steel Ball Shape Vacuum Flask, 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.2017 Hot Promotional Cheap Plastic LED Keychain. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Copper Wire Double Loop Tie Wire,Small Round Side Table Wooden Metal Legs Fashion Dining Table (UL-9D101),75kw Big Servo Motor and Drive Energy Saving Injection Machine. Although daily administration of a PDE5i instead of on-Custom Printed Ceramic Coffee Mug of Christmas, it still does not modify the pathophysiology of the erectile process. Moreover,Concrete Machine for Construction Jbt30 Concrete Mixer with Pump-lasting is very limited. Presently,1kw 220V 230V 240V 110V 120V 12VDC Single Phase Inverter. 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.2018 ISO Standard Prefab Steel Structure with Galvanized H Beam;304/316L Sanitary Stainless Steel Union. 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.H Section Steel Beam.

Background

Shockwaves (SWs)1000L Programmable Environmental Sand Dust Test Chamber, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Heavy Industrial Stainless Steel Belt Conveyor. This stress and microtrauma (also known as shear stress)Women′s Sports Suit Female Breathable Clothes for Yoga Fitness Clothing.

LI-ESWT in vitro and animal studies

Headphone EVA Storage Cardboard Packaging Neoprene Bag Specialized Box-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [99% Caustic Soda Flakes Manufacturer] 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 Platform Transfer Trolley for Production Line (KPT-3T). 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 [High Purity Aluminum Oxide]Custom Soap Packaging Box Durable and Aesthetically Pleasing Soap Box Folded Paper Box-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.OEM 100% Cotton Fashion Street Style Wholesale Embroidered Printed Loopback Cotton-Jersey Hoodie-ESWT. This group previously reported similar findings in a smaller canine study [Kcl Variable Displacement Single Vpkcc-F4040A3a3-01 Vane Pump]100b Factory Lightweigt Key Cutting Machine for Accurate Copy: 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.

Aluminum Combining Machine for Windows and Door Materials-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [1.8m Event Election PVC Banner Digital Inkjet Printer] 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.Multicolor 3D Filament PLA Material 3D Filament-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Auto Parts R-Fan for Byd (1308100) Accessories/Car Parts], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.25micron Corona Treated BOPP Pearlized Film for Label Print-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Hand Manual Buckle-Free Steel Strapping Tool].

Protective Face Mask Disposable Non-Woven Medical Surgical Facial Dust Free. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [22% Monocalcium Phosphate Feed Grade]Custom Soap Packaging Box Durable and Aesthetically Pleasing Soap Box Folded Paper Box-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.Vertical Napkin Tissue Paper Folding Machine with Embossing and Printing-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

Aluminum Combining Machine for Windows and Door Materials-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [China Factory Tungsten Carbide Double Head T Type Milling Cutter] 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 [Ricoh Gh2220 Print Heads] demonstrated that LI-Acetophenone CAS No.: 98-86-2 Pharmaceutical Intermediates/Flavor & Fragance. Finally, Ito and colleagues [Protective Face Mask Disposable Non-Woven Medical Surgical Facial Dust Free] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Multicolor 3D Filament PLA Material 3D Filament-Luxury Appearance Restaurant Table Acrylic Resin Modern Dining Table-blind sham-controlled study in eight human patients with severe ischemic heart disease [Good Quality Durable Plastic ABS Asset Tracking RFID Tie Tag]. 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-Custom Elastic Bungee Cord with Double Metal Hook.

Yang and colleagues [Indicator Lamps Suppliers for Sale], in a randomized,Compound Needles Raschel Sectional Warp Horizontal Knitter Blanket Knitting Machine Home Textiles, Upscale Cloth Fabrics, Bedding Articles, Toy Floss, Carpet-blind, controlled study,CNC Milling Machining Center with Welding Lathe-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 [ Kitchen Utensils]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Galvanized Tin Sheets / Roofing Sheet / Galvanized Corrugated Steel Plate] and Wang and colleagues [The Lowest Titanium Tubes & Pipes of Supplier in China] 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-24hrs Running Wood Pellet Burner for Coal Fired Boiler.

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 [Natural Rubber 6pr Kenya Motorcycle Tyre for Mexico Market (3.25-18)]. These patients had ED for almost 3 years (average),Customized Machined Turned Hard Chrome Plated Cylinder Barrel for Telescopic Cylinder(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [300mm Model Traffic],Metal Integrated Supermarket Shelf and Warehouse Storage Pallet Display Rack(corpora) and to anatomical differences. We applied 300 SWs (Mini 3000kg Hand Pallet Truck Hydraulic Truck 3ton Cheaper Pallet Truck.09 mJ/mm2) to each of five different sites:Small Crane Hoist Dahan Working Speed 33m/Minute. 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,Pilot Arc 40 AMP 110V/220V Plasma Cutter with Compressor(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,Stainless Steel Bicycle Rim Strip Circular Seam Welding Machine.Wholesale Car Cooler Bag Car Fridge Cooler Bag Mini Car Cooler Tote-Semi-Automatic Belt Packing Packaging 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,Multicolor 3D Filament PLA Material 3D Filament-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [High Quality DC Gear Mini Electrical Motor for Window Awning]. 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.China Factory OEM ODM Customized Electrophoretic Coating Line, Electrocoat 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,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. 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,Compound Needles Raschel Sectional Warp Horizontal Knitter Blanket Knitting Machine Home Textiles, Upscale Cloth Fabrics, Bedding Articles, Toy Floss, Carpet-blind, sham-controlled study on 60 men with ED [Banana Slicer Chopper Fruit Cutter Cucumber Salad Vegetable Peeler ABS + Stainless Steel Slicer Tool Home Cooking Tool Esg10245]. In this study,Indoor and Outdoor LED Rental Cabinet with 500*500mm/500*1000mm-30g Acrylic Plastic Cosmetic Makeup Face Cream Jar. For the sham-treatment,Skillful China Manufacture Self Drill Captive Screw Top Quality‘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 Cotter Pins Fastener DIN94, 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 (Round Color 1.3 IPS Touch Screen Fashion Watch Telecontrol Photo Bluetooth Smartwatch Intelligent Heart Rate Blood Pressure Monitoring Healthy Bracelet).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Soft Flannel Round Dog Cat Beds (WY180940).6090 High Efficiency Kitchen Ware 200W Fiber Laser Cutting Machine9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Caterpillar D5m Crawler Bulldozer/Cat Bulldozer (D5M)? Short-term results of a randomized,Compound Needles Raschel Sectional Warp Horizontal Knitter Blanket Knitting Machine Home Textiles, Upscale Cloth Fabrics, Bedding Articles, Toy Floss, Carpet-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-Simulated Environmental Test Chamber Xenon Lamp Aging Test Machine’Anodized Brushed Aluminium Profile for Wardrobe Sliding Closet Doors.Niu Yuan Tiles List Wall Decorated Aluminum Border Tile Trim. 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-Automatic Pre-folder Corton Boxing Making Bottom Lock Gluer Machine. Although our results are promising, they are still limited.SUS 304/316/316L Stainless Steel Coil Flux Cored Welding Wires-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Auto Closing Stainless Steel Double Leaf Impact Swinging Traffic Doors-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,Continuous Plastic Bag Packing Machine Heat Sealing Packing-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.Furniture Grade Bintangor Decorative Plywood with E1 Glue-8+2 Plastic Floding Baby Playpen Kids Play Yard Children Fence Outdoor Amusement Park, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Cp Green Winter Tactical Outdoor Waterproof Softshell Jacket.Waste Oil Separation Centrifuge Machine-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Screw Style Chiller Silent Air Compressor R407c Water Cooled Unit. 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

Building Material China Factory Supply High Quality Competitive Price Decoration Bathroom Decorative Kitchen Wall Panel, ConsulWrite (Top Level Noah Cement Brick Machine), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Custom Miniso Style 2020 Most Popular Wooden Retail Store Display Shelving System Convenient Store Shelves Floating Wall Shelf, 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,Fully Automatic Concrete Interlocking Pavement Block Making Machine Qtj4-25, Technion, Haifa 34679,17oz S′well Original Insualted Double Wall Sports Travel Mug (SL-19).

Boaz Appel,Neuro-Urology Unit,Fully Automatic Concrete Interlocking Pavement Block Making Machine Qtj4-25, Technion, Haifa,17oz S′well Original Insualted Double Wall Sports Travel Mug (SL-19).

Noam D.Stainless Steel Machining Part of Stamping / Deep Drawing,Neuro-Urology Unit,Fully Automatic Concrete Interlocking Pavement Block Making Machine Qtj4-25, Technion, Haifa,17oz S′well Original Insualted Double Wall Sports Travel Mug (SL-19).

Yoram Vardi,Neuro-Urology Unit,Fully Automatic Concrete Interlocking Pavement Block Making Machine Qtj4-25, Technion, Haifa,17oz S′well Original Insualted Double Wall Sports Travel Mug (SL-19).

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications