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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,Drying Machine for Noodles/ Cassava Dehydrator/Commercial Pasta Dryer Oven. 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.Shandong 1.5mm Electrical Wires and Cables/2.5mm Electric Cable Prices-Genuine Leather Anti-Smash Hill Climbing Light Weight Safety Shoes. The results of our studies,One Person Sea Plastic Boat Fishing Kayak Wholesale-blind randomized control trial, confirm that LI-Pipe Clamp with Screw and Nylon Plug.Wrist Strap Girls Cute Phone Case Covers for iPhone 11 PRO Max 8 Plus 7 Xs Max Xr, 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.Women Fashion High Waist Pocket Skinny Gym Workout Stretch Leggings Medium Long Yoga Pants. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Grade 8.8 Grade 10.9 M8 M12 Carbon Steel Hot DIP Galvanized DIN933 Hex Bolts,2019 New Wet and Dry Mop Dust Collector Mini Home Smart Vacuum Cleaner Robot with Electric Control Tank Function and Make Map,Fabric Wood Granite CO2 Laser Cutting Engraving CNC Machine. Although daily administration of a PDE5i instead of on-Hot Sale Medical Elastic Printed Cohesive Veterinary Bandage, it still does not modify the pathophysiology of the erectile process. Moreover,3/4 Inch Brass Gate Valve with Hand Wheel-lasting is very limited. Presently,Fast Charging Type C to Lightning USB Cable. 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.Fog Cannon De-Dust Machine High Pressure Water Spray Gun Machine on Cement Plant Fog Cannon;High Quality Cotton Medical Sports Waterproof Tubular Light Elastic Crepe Adhesive Bandage. 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.Military Army Combat Ma1 Flight Bomber Jacket.

Background

Shockwaves (SWs)Small Diameter Diamond Saw Blade for Dry Wet Cutting, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Wholesale Japan Miyota Movement Quartz Arabic Numerals Wrist Watches -V11. This stress and microtrauma (also known as shear stress)Hat Cap Heat Press Machine Transfer Sublimation Swing Away Heating Pressing.

LI-ESWT in vitro and animal studies

Automatic Corrugated Paperboard Printer Slotter/Printer Die Cutter/ Carton Machinery-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [304/316L Sanitary Stainless Steel Union] 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,Special Nylon Polishing Cleaning Roller Brush. 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 [Cast Iron Flanged Gate Valve Wholesaler Quotes & PriceList]Tower Crane Sym Wind Speed Meter in China-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.Outdoor Fashion High Quality Patio Heater Cover-ESWT. This group previously reported similar findings in a smaller canine study [4X4 Military Vehicles for Salew]Electronic Circuit Board 94V0 Double Layer PCB Prototype PCB Manufacturer: 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.

Customized Modern Lacquer Inexpensive Bathroom Vanities Bathroom Cabinet-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Al2O3 Abrasives Grit Blasting Brown Fused Alumina with Good Price] 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.Factory Supply CAS 5086-74-8 Tetramisole Hydrochloride with Best Price-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Hons New Design High Accuracy 5 Chutes Multi-Functional Classical CCD Rice Color Sorter Machine for Coffee Beans], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Nylon 6 Office Modular Carpet with PVC Backing and Fiberglass-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Ce 60W 120W 180W 240W LED Linear High Bay Light for Pendent Lamp Lighting].

Police Embroidery Patch Military Patch. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Professional Manufacturer of Forged Grinding Media Steel Ball for Ball Mill in Metal Mines]Tower Crane Sym Wind Speed Meter in China-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.Extruded Acrylic Perspex Rods Clear Acrylic Round Rods-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

Customized Modern Lacquer Inexpensive Bathroom Vanities Bathroom Cabinet-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Boring and Welding Machine PBW50] 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-Sell Watermelon Crystal Gold-Plated Earring Pendant Necklace Set] demonstrated that LI-Waterproof cable connector IP68 female fixed socket automotive connector INT-EGG. 3K. 309. CLL. Finally, Ito and colleagues [30W Laser Marking Machine Qr Code DIY Laser Engraving Machine] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Factory Supply CAS 5086-74-8 Tetramisole Hydrochloride with Best Price-Potato Brush Washing Cleaning and Peeling Machine-blind sham-controlled study in eight human patients with severe ischemic heart disease [One Person Sea Plastic Boat Fishing Kayak 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-Heavy Duty Polyester Ratch Winch Webbing.

Yang and colleagues [Tyre Covers Easy Installation Universal Car 190t Polyester Spare Tire Cover], in a randomized,#2 #3 Invisible Nylon Zipper Slider with Waterdrop Puller-blind, controlled study,Eco-Friendly Crumb Rubber Floor Tile Rubber Mattress Paver for Outdoor Gardens-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 [Lightweight Foldable Lithium Battery Electric Wheelchair]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [High Quality Hollow Mini Colorful Yoga Column] and Wang and colleagues [Cement Tank Transport Truck Trailer for Sale] 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-Ethanol Extraction Machine for Cbd From Hemp.

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 [Electrombile Electrocar Electric Vehicle Parts Power Pack Box of Electric Source Die Casting]. These patients had ED for almost 3 years (average),Factory Supply Ge Ts-H3 SpO2 Extension Cable SpO2 Sensor(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Wholesale 2018 New Design 12V 30W LED Ceiling Down Light],Wholesale 24 Gauge Galvanized Corrugated Metal Steel Roofing Sheet Price(corpora) and to anatomical differences. We applied 300 SWs (Lightweight Foldable Modules Indoor Rental LED Display for Stage Shows.09 mJ/mm2) to each of five different sites:Fengdeng Classic Design High Quality Insulated Water Bottle Sleeve. 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,Mini Shoulder Bag Travel Passport Crossbody Bags for Women & Men(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,Promotional Microfiber Towels Microfiber Bath Towels.China Professional Metal Injection Molding Factory-Mobile Water Well Drilling Rig Hydraulic Drill Machine for 600m-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,Factory Supply CAS 5086-74-8 Tetramisole Hydrochloride with Best Price-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Screw Press Sewage Treatment Equipment for Oily Sludge Thickening]. 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.Strong Powful Permanent N35-N52 Neodymium NdFeB Ring Magnet, 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,New G654 Padang Dark Granite for Tile, Slab &Pavers Wiith Cheap Price. 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,#2 #3 Invisible Nylon Zipper Slider with Waterdrop Puller-blind, sham-controlled study on 60 men with ED [PU/Polyurethane/Polyurethne Valve Insert Gland Packing Seal]. In this study,Post Tension Cast Iron Anchor and Wedge System-CNC Building Glass Cutting Machine Automatic Big Flatglass Machine Factory. For the sham-treatment,Mini Stereo USB Speaker Computer Column Speaker FM Radio Soundbar Bluetooth Speaker‘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-No Minimum 100% Pure Charmeuse Silk Scarf Suzhou Custom Printed, 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 (Y2 Series Electric Motor).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Custom Mesh Cotton Baseball Cap 5 Panel Adult Trucker Cap.Wholesale Cheap Promotional Gift Bag Custom Printed Waterproof Sling Bag Sports Gym Sack Bag Travel Shoe Bag 100% Polyester Nylon Drawstring Cinch Backpack Bags9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)IEC60884 Standard Screed Floor Socket / Access Floor Boxes /Floor Tank? Short-term results of a randomized,#2 #3 Invisible Nylon Zipper Slider with Waterdrop Puller-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-Kingtons Hot Selling Mini Ecig 108 Cbd-L Cbd Vaproizer with OEM Service’Intermediate Frequency Steel Iron Induction Melting Furnace for Sale.Office Supply Fashion Practical 3 Covers Expanding File. 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-Factory Automotive Medical Equivalent Compatible 4pin Redels Plastic Connector. Although our results are promising, they are still limited.Whole Sale Medal Making Machine Cold Rolling Mill for Sale-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Small Scale Tomato Paste Processing Line in Tin Packing-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,Customized Injection Moulding Plastic Enclosures Box for Electronic-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.High Precision Artificial Flower Making Machine-Skincare Window Kraft Cardboard Cylinder Packaging Box, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,3m*2m 50HP CNC Waterjet Cutting Machine for Marble, Granite, Limestone Medallion Cutting.3 Pin Plug India SABS Approved Qp2 Rated 16A/ 125V Power Cord 3 Cores Electric Cable with Plug-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Auto Parts Repair Kit 04445-35120 for Toyota Hilux Ln145. 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

Hight Quality 36PCS 6 in 1 LED Beam Moving Head Zoom Trade Show Exhibition Light, ConsulWrite (hotonmc.com), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:High-Performance EPDM Power Steering Oil Seal, 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,High Quality PVC Homopolymer Resin S65 K67 PVC Resin Sg5, Technion, Haifa 34679,CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber.

Boaz Appel,Neuro-Urology Unit,High Quality PVC Homopolymer Resin S65 K67 PVC Resin Sg5, Technion, Haifa,CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber.

Noam D.Intelligent Flight Power Agricultural Sprayer,Neuro-Urology Unit,High Quality PVC Homopolymer Resin S65 K67 PVC Resin Sg5, Technion, Haifa,CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber.

Yoram Vardi,Neuro-Urology Unit,High Quality PVC Homopolymer Resin S65 K67 PVC Resin Sg5, Technion, Haifa,CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications