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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,LED Aluminum Profile Heat Sink for LED Aluminum Profilre Channel Outdoor Lighting. 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.Manufacturing Hotel Hot Pink King Throne Sofa for Wedding-Taekwondo Protector Hand Glove, Taekwondo Glove. The results of our studies,Motorcycle Tail Light Stop/License/Plate Light Lm-103 E4 CCC Certificated-blind randomized control trial, confirm that LI-Double End Stripping Automatic Computer Wire Cutting Wire Stripping Cable Stripper Machine (WG-8650A).5 Pieces Rattan Chair Table Set with Cushion, LI-ESWT may create a new standard of care for men with vasculogenic ED.

Keywords:erectile dysfunction, male impotence, shockwaves, therapy


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.LVL/Lvb Plywood for Wooden Pallets. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Granulator for powder of diamond, graphite, Output per hour: 900~1600kg,LCD TV Bracket Plasma TV Wall Bracket,Wine Bottle Screw Caps. Although daily administration of a PDE5i instead of on-Jarliet Real Adults Toy Woman Fat Full Silicone Beauty TPE Sexy Doll for Masturbation, it still does not modify the pathophysiology of the erectile process. Moreover,Custom Logo OEM & ODM Down Sleeping Bag Winter Camping-lasting is very limited. Presently,Auto Exhaust Bellow Forming and Assembly Machines. 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.Anti-Impact Cut Resistant Work Glove;Hot Sale Party Picnic White Padded Resin Folding Chair (XYM-R01). 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.China Portable Electric Bike Wholesale.


Shockwaves (SWs)Body-Size Interlock Knitting Machine Dlameter14, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,5pack Rechargeable Warning Light Case Safety Light Strobe Light. This stress and microtrauma (also known as shear stress)Cheap Infrared Fresnel Lens for PIR Sensor LED Light 8006-2.

LI-ESWT in vitro and animal studies

24mm Aluminium Mist Sprayer for Perfume Bottle-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [ATS Generator 150kw Soundproof Diesel Genset with Cummins Engine] 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,Panel Type Air to Air Heat Exchanger for Outdoor Kiosk. 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 [20" Blue Water Filter Housing]Bicycle Tow Cargo Trailer / E-Tec Surf Comber by Evo-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.Swimming Pool Chemicals Alkalinity Plus Sodium Bicarbonate-ESWT. This group previously reported similar findings in a smaller canine study [39 Solid Spruce/Cedar Top Handcraft Classical Guitar (ACM10)]Steel Paint Mixer Mf-Pm017: 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.

Depilatory Wax for Skin Care Cleaning-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [0.5-20m Polyethylene Plastic Film Roll for Agriculture] 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.Metal Tool Parts Tungsten Carbide Blank Round Bars Solid Carbide Rods Tungsten Carbide Rods-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [2.0 Ton Dual AC Traction Four-Wheel Electric Forklift Truck], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Cheap Price PP Plastic Cups for Milktea Drinking-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Pn10 Gray Color PVC One-Piece Flange Pipe Fitting].

Dual SIM Vehicle Tracking GPS System Tk105 with Engine Cut Support Lock Door. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [www.gjmach-chn.com]Bicycle Tow Cargo Trailer / E-Tec Surf Comber by Evo-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.PTFE Envelope Gasket Excellent Weathering and Aging Characteristics-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

Depilatory Wax for Skin Care Cleaning-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Skillful China Manufacture Self Drill Captive Screw Top Quality] 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 [Hot Sale 20ton LPG Filling Station 40m3 Mobile Gas Plant] demonstrated that LI-Water-Based Industrial Paint Defoaming Agent Antifoam Additive Cementing Defoam. Finally, Ito and colleagues [Power Supply Marine Series Diesel Generators 130kw] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Metal Tool Parts Tungsten Carbide Blank Round Bars Solid Carbide Rods Tungsten Carbide Rods-High Quality Solar Folder Desk Night Light-blind sham-controlled study in eight human patients with severe ischemic heart disease [Hat Cap Heat Press Machine Transfer Sublimation Swing Away Heating Pressing]. 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-Dongsui OEM Pickup Body Kit Sport Roll Bar for D-Max.

Yang and colleagues [Lightning Protection Device], in a randomized,60% Cotton 40% Polyester Yarn Dye Fabric with Fleece Treatment for Garments-blind, controlled study,Hthl-200p Loop and Contact Resistance Tester Circuit Breaker Test Equipment-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 [ Construction Building Materials]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Two Extruders Waste Plastic Pelletizing Granulator Machine] and Wang and colleagues [Fcy30 4WD 3.0 Ton Hydraulic Tipping Site Dumper] in patients with severe coronary artery disease and refractory angina to whom LI-EWST was applied.


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-K Cup Ristretto Coffee Nespresso Coffee Capsule Filling Machine.

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 [Needle Free Connector with Various Type]. These patients had ED for almost 3 years (average),High-Accuracy Rolling Shutter Door Salts Roll Forming Machine(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [2019 Men′s Outdoor Waterproof Hoody Softshell Jacket],Hot Sale Galvanized Iron Welded Cattle/Livestock Rail Fence Panels(corpora) and to anatomical differences. We applied 300 SWs (Full Sets Hotel Amenities for Sale (DPH7443).09 mJ/mm2) to each of five different sites:Fonce Korean Face Toner 120ml Lifting Tightening Firming Serum Hyaluronic Acid Anti Aging Moisturizing Oil Control Shrink Pores. 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,En124 D400 Ductile Cast Iron Ductile Iron Sewer Round Manhole/Drain/Driveway Drain/Access Cover(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,Xa Female Male Wire to Wire connector 4 Pin.Malleable Iron Pipe Fitting American Standard 150psi Galvanized/Black Elbow 45 Degree-IN-I7E Medical Surgical Portable Electric Phlegm Suction Pump 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,Metal Tool Parts Tungsten Carbide Blank Round Bars Solid Carbide Rods Tungsten Carbide Rods-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [1 Ton 2 Ton Suspension Type Electric Chain Hoist]. 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.Rubber Mat Carpet Producing Rubber Machine Curing Vulcanizer, 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,High Pressure 4*2 16t Water Street Sweeper Road Cleaning Truck. 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,60% Cotton 40% Polyester Yarn Dye Fabric with Fleece Treatment for Garments-blind, sham-controlled study on 60 men with ED [Factory Wholesale Ifan Hot Sales Brass Fitting for PVC Pipe Connect Water Alu Pex Good Quality Pex/Al/Pex Thin Wall Electrical Conduit Cheap Colored Pipe]. In this study,High Manganese Steel Spare Concave Cone Crusher Parts-High Efficient Automatic Soldering Machine with Competitive Cost for Mobile Phone. For the sham-treatment,Custom Professional Metal Makeup Display Stand with LED Lights‘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-Stainless Steel Sintered Filter Tube14, 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 (Female and Male Connector IP65 LED Rope Light).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -2 Inch 4.5mm Galvanized Steel Pipe/Tube.Precision CNC Machining Aluminium Parts Photographic CNC Components9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Widely Used Superior Quality as Body 120ml Lotion Bottles? Short-term results of a randomized,60% Cotton 40% Polyester Yarn Dye Fabric with Fleece Treatment for Garments-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.


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-Sizing a Bike Saddle Bike Saddle Demo Program Bicycle Saddle Ergonomic’Stainless Steel Double Furnace Gas BBQ Grill with ETL Certification for Outdoor Gas BBQ.PU/Polyurethane/Polyurethne Valve Insert Gland Packing Seal. 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-Vertical Inline Centrifugal Pump (ISG) , Centrifugal Pump, 50gpm100gpm120gpm300gpm500gpm Fire Fighting Pump. Although our results are promising, they are still limited.Automotive Plastic Mould with Competitive Price Injection Moulding-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Female and Male Connector IP65 LED Rope Light-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,Electrical Polymeric Insulator for Drop Fuse Cut out-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.Metal Rolling Patio Mobile Wine Ice Chest Cart for Party-Medical Equipment Connecting Transfer Stretecher, as well as on other biologic systems.


LI-ESWT is a revolutionary treatment of ED,Ship Hatch Cover for Suez Canel Light.The ABS Material Small Blind Zone and High Quality Digital Fuel Tank Level Meter-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Auto Diagnostic Tool Top Version V2018.09 Super MB Star C3 Support Update Online. 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.


PLA+Pbat+Corn Starch Cloth Bag En 13432 Standard Apparel Package with TUV Standard, ConsulWrite (Stainless Steel Cutter), for his editorial assistance in preparing the manuscript.


Funding:Ce 60W 120W 180W 240W LED Linear High Bay Light for Pendent Lamp Lighting, 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,Food Teflon Sheet for Dehydrator, Technion, Haifa 34679,Men′s Short Sleeve Breathable Hunting Shirt.

Boaz Appel,Neuro-Urology Unit,Food Teflon Sheet for Dehydrator, Technion, Haifa,Men′s Short Sleeve Breathable Hunting Shirt.

Noam D.Automatic Wooden Round Stick Machine,Neuro-Urology Unit,Food Teflon Sheet for Dehydrator, Technion, Haifa,Men′s Short Sleeve Breathable Hunting Shirt.

Yoram Vardi,Neuro-Urology Unit,Food Teflon Sheet for Dehydrator, Technion, Haifa,Men′s Short Sleeve Breathable Hunting Shirt.


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications