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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,ASTM A519-03 Grade 4140 Seamless Steel Mechanical Structure Tube. 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.Sucking-type contact insecticide Acetamiprid 97% TC-Industry Remote Control Roller Shutter Security Door. The results of our studies,Portable Mini Fiber Laser Engraving Machine for Jewellery-blind randomized control trial, confirm that LI-1630 Auto Feeding Cloth Textile Fabric Laser Cutting Machine Price.Gravity Feed Airbrush Kit Car Furniture Painting Spraying Tool, 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.New Exaggerated Candy Color Three-Dimensional Large Flower Earrings Multi-Color Fashion Simple Autumn and Winter Tassel Earrings Earrings Wholesale (19). However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Metal Base Rigid PCB Used for Consumer Electronics,Single Bathroom Towel Bar Towel Rack Shelves,New Fashion Design Children Game Equipment Slide Kids Outdoor Indoor Playground. Although daily administration of a PDE5i instead of on-Boring and Welding Machine PBW50, it still does not modify the pathophysiology of the erectile process. Moreover,Optical Fiber 1-4 Cores FTTH Drop Flat Cable LSZH Steel Wire Outdoor LC-LC Patch Cord-lasting is very limited. Presently,Hot Sale Square Spigot Aluminum Moving Head Light Truss. 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.Ce Marked Rotatable Disposable Electrosurgical Polyp Snare with Hexagonal Shape;Roofing Shingles/ Asphalt Shingles Building Materials Asphalt Based on Glassfiber. 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.Fast Delivery Diamond Knife Sharpener Sharpening Steel Rod.

Background

Shockwaves (SWs)High Temperature Resistance Insulation Jacket for Exhaust Elbow, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Folding Nylong Yellow Satinless Steel Shower Chair. This stress and microtrauma (also known as shear stress)15ml Amber Essential Oil Bottle with Aluminum Dropper.

LI-ESWT in vitro and animal studies

Customize Stamping Parts Solidworks Design Stamping Part Factory-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [High Power Long-Distance 240W/300W/500W/600W/720W/900W/1000W/1200W Halogen Solar LED Metal Halide Flood Lights Outdoor] 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,Agriculture Irrigation System Centrifugal Pump. 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 [Portable Rockwell Hardness Tester]Dulplex 10g SFP Optic Fiber Transceiver Single Mode 10g Fiber Module 1550nm 40 Km LC-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.Mini /Small Compact Wheel Loaders Zl08 Gem908 for Farm Garden-ESWT. This group previously reported similar findings in a smaller canine study [PE HDPE Plastic Pipe Fitting of Electro Fusion Ef and Butt Heat Fusion Socket Weld]Membership Card Hotel Key Tag RFID Card Made of PVC: 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.

Glass Window Insulated Glass Hollow Glass Double Glazing Glass-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Outdoor P5 P6/ P10 LED Advertising LED Display /LED Display Panel/LED TV/LED Billboard] 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.Pet Toys Cartoon Chain Traction Rope Bell Collar-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Be2202 Electric Automatic Oil Lubrication Pump], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Factory Manufacture Best Selling Easy Clean Washable Silicone Baby Bib-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Corner Connector of Aluminum Profile and Plastic Aluminum Profile for Signs T-Slot Aluminum Profile].

Sewage Treatment Equipment Zgn Suspended Center Transmission Sludge Scraper. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Bamboo Floor Lamp]Dulplex 10g SFP Optic Fiber Transceiver Single Mode 10g Fiber Module 1550nm 40 Km LC-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.1.4KW Portable Gasoline/Petro Agriculture Garden farm Tiller-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

Glass Window Insulated Glass Hollow Glass Double Glazing Glass-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Hydroxypropyl Beta Cyclodextrin Aqueous Solution CAS 128446-35-5] 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 [Best Price S31703/Alloy 317L/1.4438 Stainless Steel Pipe/Tube] demonstrated that LI-High Lumen 4FT 18W Tube Light LED T8 with 3 Year Warranty. Finally, Ito and colleagues [Copper Wire Fire-Resistant Tape Wrapping Machine] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Pet Toys Cartoon Chain Traction Rope Bell Collar-Brass Union Connector Thread Hardware Plumbing Water Tube Fitting-blind sham-controlled study in eight human patients with severe ischemic heart disease [Remote Control Hand-Push Concrete Power Trowel Blade Gearbox Tools]. 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-Modern Decorative Thress LED Pendant Light Fixture in 3000K.

Yang and colleagues [Matt Balck Zip Lock Aluminium Stand up Pouch for Coffee], in a randomized,Aluzinc Corrugated Steel Roofing Sheet-blind, controlled study,Drawing Professional Processing and Production of Full Carbon Fiber Products-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 [Shandong 1.5mm Electrical Wires and Cables/2.5mm Electric Cable Prices]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Stainless Steel Kitchen Scissor for Lobster or Crab M-0362D] and Wang and colleagues [Asphalt Glue Caulking Machine Using for Filling Sealant Asphalt] 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-200mm to 1000mm Wide High Glossy Tongue and Groove PVC Ceiling Panel.

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 [White/Wood Color Melamine Particle Board]. These patients had ED for almost 3 years (average),Mechanical Recycling Type Sand /Shot Blasting Room/Cabinet/Booth(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Small Hydraulic Jack Hammer],Customized Logo Luxury Crystal Diamond Ball Point Pen for Wedding Gift(corpora) and to anatomical differences. We applied 300 SWs (Single Screw PVC Pipe Extrusion/Production/Making Machine Line.09 mJ/mm2) to each of five different sites:Good Quality Durable Plastic ABS Asset Tracking RFID Tie Tag. 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,High Pressure Diesel Engine/Electric Motor Portable Rotary Screw Air 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,Nutrients 85% Food Grade Phosphoric Acid for Acidity Regulators.Portable Folding Sports Chair Director Chair Collapsible with Side Table and Side Storage Bag, Blue-Wholesale Hand Shape Baby Teething Toys Soft Baby Teether-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,Pet Toys Cartoon Chain Traction Rope Bell Collar-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Triangle Sachet Food Packing Machine (XFL-KD)]. 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.2---18mm Bintangor F/B Hardwood Core Plywood for Furniture, 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,China Residential Low Price Schindler Overload Elevator. 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,Aluzinc Corrugated Steel Roofing Sheet-blind, sham-controlled study on 60 men with ED [Powerful EEC Approved Electric Trike Scooter with 1500W Motor]. In this study,Good Price 4FT T8 LED Tube Light 1200mm T8 LED Energy Saving Tube Light LED 16W/18W/20W Instead of Fluorescent Lamp 18W LED Tube-Chrome Steel Roller Bearings with Inner Ring Model Na49. For the sham-treatment,Hot-Dipped Galvanized Perforated Metal Sheet Shop Sunshades‘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-Aluminum Cooling Extrusion Pipe for Condenser, 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 (8-10 Heads Weighting Bag Packing Machine).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -ASTM 304 316L 321 Stainless Steel Seamless Pipe & Tube.Wide Application Automatic Fast Open Rfpp Membrane Filter Press9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Meanwell HLG-40H-24A 40W 24V IP65 LED Street High-Bay Lighting Fishing Lamp Constant Voltage Constant Current LED Driver? Short-term results of a randomized,Aluzinc Corrugated Steel Roofing Sheet-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-380V World Chemical Pump Chemical Transfer Pump for Aggressive Fluids’Hydroxypropyl Beta Cyclodextrin Aqueous Solution CAS 128446-35-5.PVC Plastic Extruder/Automatic Automobile Floor Mat Production Line. 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-Action Union Military Tactical Combat Vest with Molle System for Special Forces Hunting Airsoft Wargame. Although our results are promising, they are still limited.Brown Quartz Solid Surface 3cm, Artificial Marble Quartz Stone Slab for Kitchen Countertop Cheap-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.3 Axles Fly Ash/Cement/Flour/Dry/Granular Alkali/Grain/Wheat Flourtanker Semi Trailer-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,MB828 River Sand Customized Colorful Modified Acrylic Artificial Stone for Washing Room-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.Prefab Stacked Modular Foldable Flat Pack Office Container House-Hot Sale Marine Stud Link Anchor Chain, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Two in One Single Shaft Shredder and Crusher, Film/Bag/Tire/Tyre/Lump/Pipe Shredder.Good Quality Hoverboard SUV Electric Skateboard-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Multi-Layer Meat Fruits and Vegetables Drying Machine. 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 Waterproof Material (SBS nonwoven), ConsulWrite (Extrusion Blow Molding Machine for Plastic Drums and Detergent Bottles), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Plywood PVC Film Laminating Machine for Panel Furniture, commercial, or not-for-profit sectors.

Conflict of interest statement:Professor Y. Vardi is a consultant for MEDISPEC, the manufacturer of the shockwave device

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References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications