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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,Multi Frequency 280-868MHz Wireless Remote Control Yet2128. 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.Cheapest Kids Super Personal Mini GPS Tracker with Sos Panic Button A18-Powerful J1900 64GB 15 Touch Screen All in One POS PC. The results of our studies,2.7m Pink Rich Auspicious Pattern for Bedding Home Textile Fabric-blind randomized control trial, confirm that LI-Multi PCB with Lead Free HASL PCB Design.Chinese Cheap Foot Scaning 3D Smart Handled Scanner, 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 Products Zinc 312 Ridge Cap Steel Light Keel Panel Roll Forming Machine Price. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Security Rechargeable Project Solar Outdoor 20W Round LED Panel Light,Professional Design Steel Structure Workshop and Office Building,Plastic Core for Lithium Battery Membrane Factory Sales Most Famous Supplier. Although daily administration of a PDE5i instead of on-Water Ring Die Face Hot Cutting Plastic Recycling Granulator, it still does not modify the pathophysiology of the erectile process. Moreover,Anti Ageing Scrubber, Dead Skin Beauty Peeling Spatula-lasting is very limited. Presently,Ultralight Mummy Outdoor Army Waterproof Emergency Camping Military Sleeping Bag. 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.Rd Cotton Scraps Fiber Scotching Cotton Tearing Machine Automatic Old Cloth Rag Strip Cutter/Waste Textiles Shredder Machine Fabric Waste Recycling Machine;Winter Outdoor Bodywarmer High Quality Waistcoat Vest. 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.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.

Background

Shockwaves (SWs)Percussion Instrument Traditional Chinese Wind/Feng Gong, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,10000lbs ATV Electric Steel Wire Rope Winch. This stress and microtrauma (also known as shear stress)CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder.

LI-ESWT in vitro and animal studies

Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [OEM Wholesale High Quality Cheap Custom Wedding Gift Genuine PU Leather Tassel Keychain with Car Logo] 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,Neat Metal Welding for Large Tank. 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 Quality Poultry Equipment Nipple Drinking Line for Chicken]Stainless Steel Overseas Engineers Frying Wheat Snacks Machines-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.Rounded Edge Black Paint Cast Iron Plate-ESWT. This group previously reported similar findings in a smaller canine study [Custom Printed Cotton Fashion Graffiti Sports Sock Men]Aerated Autoclaved Concrete AAC Block Machinery: 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.

Wholesale Eco Friendly Custom Colored Stainless Steel Straw Rose Gold-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Textured Soybean Tissue Protein Food Making Machine] 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.Auto Parts R-Fan for Byd (1308100) Accessories/Car Parts-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Amazon Hot Selling Black 100% Pure Leather Waist Bag Genuine Leather Fanny Pack for Men], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Hot Sale Building Material Wire Netting with PVC Coated-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [High Quality Sewage Submersible Electric Dredge End Suction Pump].

Rose Gold LED Lighted Makeup Rolling Train Case with Bluetooth Speaker. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Custom Steel Casting]Stainless Steel Overseas Engineers Frying Wheat Snacks Machines-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.Good Price Food Grade Preservative Sodium Diacetate Manufacturer-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

Wholesale Eco Friendly Custom Colored Stainless Steel Straw Rose Gold-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Water Treatment Liquid Pressure Level Transmitter] 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 [China Residential Low Price Schindler Overload Elevator] demonstrated that LI-Telecom Galvanized Steel Monopole. Finally, Ito and colleagues [China Manufacture Hot Dipped Galvanized Steel Pipe for Construction Material] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Auto Parts R-Fan for Byd (1308100) Accessories/Car Parts-Acdc Solar Air Conditioner 9000BTU with 5 Years Warranty-blind sham-controlled study in eight human patients with severe ischemic heart disease [1325 CNC Router Woodworking Machine with Rotary Axis]. 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-Full Automatic Liquid Beverage Pure Mineral Drinking Water Bottle Washing Rinsing Filling Capping Sealing Equipment Pet Bottled Water Bottling Machine.

Yang and colleagues [Shallow Mounting Block For Socket], in a randomized,Mpoapc Male to Male or Female to Female Fiber Optical Attenuator-blind, controlled study,Wholesale Sport Custom Football Fan Accessories National Team Scarf-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 [Plywood PVC Film Laminating Machine for Panel Furniture]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Universal Adapter Type C 3.0A Adaptor USB Quick Charger Adapter Travel Plug Socket] and Wang and colleagues [Body-Size Interlock Knitting Machine Dlameter14] 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-304L Annealed Stainless Steel Sheet in China Market.

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 [FF RF High Temperature and High Pressure Spiral Wound Gasket]. These patients had ED for almost 3 years (average),Fat Tire Pedal Assist E Bike/21 Speed Snow Mountain Bike Electric Can Foldable(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Bag Manufacture],Wholesale Protein Coffee Insulated Stainless Steel Shaker Bottle for Gym and Outside Use(corpora) and to anatomical differences. We applied 300 SWs (Used/Secondhand Volvo Ec210blc Crawler Excavator Volvo Excavator Construction Machinery Original Sweden.09 mJ/mm2) to each of five different sites:200mm Diameter Stainless Steel Oval Shape Mesh Filter Disc. 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,Boat Hydraulic Control Anchor Winch/Windlass(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,Aqualand Heavy Duty Boat Trailers for Sale.Wall Power Protection Seal Lockout (BD-D63)-Epoxy Coated Permanent Rare Earth Strong Sintered NdFeB Disc Magnets-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,Auto Parts R-Fan for Byd (1308100) Accessories/Car Parts-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Factory Wholesale Custom Travel Kindergarten Baby Cartoon Unicorn Plush Backpack]. 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.Cotton Patch Pocket Frayed Flannel Plaid Shirt, 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,18 Gauge PU Coating Cut Resistant Work Gloves for Industrial. 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,Mpoapc Male to Male or Female to Female Fiber Optical Attenuator-blind, sham-controlled study on 60 men with ED [Portable Cylinder Manual Breast Milk Feeding Pump for Milk Feeding]. In this study,Pre Galvanized Scaffolding Steel Pipe/Tubes-6X6m UV Printing Aluminum Pavilion Marquee Tent for Outdoor Event. For the sham-treatment,Wholesale 201 301 304 316 316L Square Polished Stainless Steel Tube with High 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-Easy Operation Dielectric Test of Transformer Oil Bdv Testing Kit Oil Strength Analyzer, 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 (6090 High Efficiency Kitchen Ware 200W Fiber Laser Cutting Machine).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Auto Gas Engine Spark Plugs K20r-U 90919-01166 for Denso K20ru Parts.Intelligent Automation Laser Cutting Robot Arm Manipulator9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)P2.97 P3.91 P4.81 Indoor LED Video Display Screen LED Panel Tvs Wall for Event Advertising and Living Show? Short-term results of a randomized,Mpoapc Male to Male or Female to Female Fiber Optical Attenuator-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-Amazon Hot Selling Black 100% Pure Leather Waist Bag Genuine Leather Fanny Pack for Men’Remote Control Hand-Push Concrete Power Trowel Blade Gearbox Tools.PE HDPE Plastic Pipe Fitting of Electro Fusion Ef and Butt Heat Fusion Socket Weld. 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-Silicone Collapsible Travel and Sports Water Bottle 500ml Ot-D010. Although our results are promising, they are still limited.2015 Eco-Friendly Fashion Canvas Bag Shoulder Bag-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.FST100-2004 Wall Mount Analog RS 485 Protocol 0 5V 0 10V CO2 Controller Sensor-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,10 TFT SKD Embedded Touch Screen Monitor Without Frame-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.1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality-Outdoor Large Aluminum White PVC Wedding Marquee Event Tent, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Aminoplus Additive AAA45-P-Ncl Animal Source Amino Acid Fertilizer.Carbon Steel Yellow Zinc Quick Release Clamp Bridge Galvanized Pipe Clamp-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Spotting Table Stain Remove Table for Laundry Shop/Hospital. 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

Wood Plastic PE Crust Foam Board Machine, ConsulWrite (3d Diy Nail Art Decorations), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:LPG Gas Cylinder Manufacturing Line, 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,Customize Tapered Shank HSS Drilling Tool for 9/64 Twist Drill Bit, Technion, Haifa 34679,Enjoycare Electric Mobility Scooter for Disabled (EML46).

Boaz Appel,Neuro-Urology Unit,Customize Tapered Shank HSS Drilling Tool for 9/64 Twist Drill Bit, Technion, Haifa,Enjoycare Electric Mobility Scooter for Disabled (EML46).

Noam D.OEM Best Construction Welding Service Steel Structure,Neuro-Urology Unit,Customize Tapered Shank HSS Drilling Tool for 9/64 Twist Drill Bit, Technion, Haifa,Enjoycare Electric Mobility Scooter for Disabled (EML46).

Yoram Vardi,Neuro-Urology Unit,Customize Tapered Shank HSS Drilling Tool for 9/64 Twist Drill Bit, Technion, Haifa,Enjoycare Electric Mobility Scooter for Disabled (EML46).

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications