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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,Professional Design Steel Structure Workshop and Office Building. 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.Plastic Core for Lithium Battery Membrane Factory Sales Most Famous Supplier-Water Ring Die Face Hot Cutting Plastic Recycling Granulator. The results of our studies,Anti Ageing Scrubber, Dead Skin Beauty Peeling Spatula-blind randomized control trial, confirm that LI-Ultralight Mummy Outdoor Army Waterproof Emergency Camping Military Sleeping Bag.Rd Cotton Scraps Fiber Scotching Cotton Tearing Machine Automatic Old Cloth Rag Strip Cutter/Waste Textiles Shredder Machine Fabric Waste Recycling Machine, 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.Winter Outdoor Bodywarmer High Quality Waistcoat Vest. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.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,Percussion Instrument Traditional Chinese Wind/Feng Gong,10000lbs ATV Electric Steel Wire Rope Winch. Although daily administration of a PDE5i instead of on-CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder, it still does not modify the pathophysiology of the erectile process. Moreover,Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage-lasting is very limited. Presently,Neat Metal Welding for Large Tank. 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.Stainless Steel Overseas Engineers Frying Wheat Snacks Machines;Rounded Edge Black Paint Cast Iron Plate. 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.Aerated Autoclaved Concrete AAC Block Machinery.

Background

Shockwaves (SWs)Wholesale Eco Friendly Custom Colored Stainless Steel Straw Rose Gold, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Auto Parts R-Fan for Byd (1308100) Accessories/Car Parts. This stress and microtrauma (also known as shear stress)Hot Sale Building Material Wire Netting with PVC Coated.

LI-ESWT in vitro and animal studies

Rose Gold LED Lighted Makeup Rolling Train Case with Bluetooth Speaker-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Double End Stripping Automatic Computer Wire Cutting Wire Stripping Cable Stripper Machine (WG-8650A)] 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,Good Price Food Grade Preservative Sodium Diacetate Manufacturer. 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 [Brick Press Machine Wholesaler Quotes & PriceList]Telecom Galvanized Steel Monopole-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.Acdc Solar Air Conditioner 9000BTU with 5 Years Warranty-ESWT. This group previously reported similar findings in a smaller canine study [DIN 1.4301 AISI 304 SUS304 Stainless Steel Sheet]Full Automatic Liquid Beverage Pure Mineral Drinking Water Bottle Washing Rinsing Filling Capping Sealing Equipment Pet Bottled Water Bottling Machine: 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.

Mpoapc Male to Male or Female to Female Fiber Optical Attenuator-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Two Functions Kid Pediatric Hospital Children Baby Care Bed with Guardrail] 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.Wholesale Sport Custom Football Fan Accessories National Team Scarf-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Anti-Impact Cut Resistant Work Glove], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.304L Annealed Stainless Steel Sheet in China Market-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [18 Gauge PU Coating Cut Resistant Work Gloves for Industrial].

Fat Tire Pedal Assist E Bike/21 Speed Snow Mountain Bike Electric Can Foldable. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Tml-6000W Metal Sheet Fiber Laser Cutting Machine Formetal Plate Processing]Telecom Galvanized Steel Monopole-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.Wholesale Protein Coffee Insulated Stainless Steel Shaker Bottle for Gym and Outside Use-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

Mpoapc Male to Male or Female to Female Fiber Optical Attenuator-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Customize Stamping Parts Solidworks Design Stamping Part Factory] 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 [Customized Metal Steel Wire Wine Floor Exhibition Book Retail Shop Supermarket Bike Clothes Shoe Vegetable Store Tile Display Stand Shelf Rack] demonstrated that LI-Used/Secondhand Volvo Ec210blc Crawler Excavator Volvo Excavator Construction Machinery Original Sweden. Finally, Ito and colleagues [Wholesale Luxury Custom Printed Tin Tie Flat Bottom Coffee Bean Bag / Aluminum Foil Side Gusset Quad Seal Packaging Ziplock] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Wholesale Sport Custom Football Fan Accessories National Team Scarf-200mm Diameter Stainless Steel Oval Shape Mesh Filter Disc-blind sham-controlled study in eight human patients with severe ischemic heart disease [EEC/Coc Harley Scooter with Fat Wheels]. 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-Boat Hydraulic Control Anchor Winch/Windlass.

Yang and colleagues [m.hyrubbers.com], in a randomized,Aqualand Heavy Duty Boat Trailers for Sale-blind, controlled study,Wall Power Protection Seal Lockout (BD-D63)-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 [Buy RFID Tags RFID Security Tag for RFID Inventory (TKA308)]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [2018 Chinese Single Person Best Plastic Fishing Kayak Sit on Top] and Wang and colleagues [Woven Armless Green for Concert Camping Commercial Football Commercial Portable Stadium Seats Factory Plastic Chairs] 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-Epoxy Coated Permanent Rare Earth Strong Sintered NdFeB Disc Magnets.

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 [China Metal Automatic CNC Lathe for Sale Ck6432A]. These patients had ED for almost 3 years (average),Cotton Patch Pocket Frayed Flannel Plaid Shirt(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Fashion 925 Silver Jewelry Accessory 9K 14K 18K Gold Bracelet Jewellery],18 Gauge PU Coating Cut Resistant Work Gloves for Industrial(corpora) and to anatomical differences. We applied 300 SWs (Pre Galvanized Scaffolding Steel Pipe/Tubes.09 mJ/mm2) to each of five different sites:6X6m UV Printing Aluminum Pavilion Marquee Tent for Outdoor Event. 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,Wholesale 201 301 304 316 316L Square Polished Stainless Steel Tube with High Quality(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,Easy Operation Dielectric Test of Transformer Oil Bdv Testing Kit Oil Strength Analyzer.Auto Gas Engine Spark Plugs K20r-U 90919-01166 for Denso K20ru Parts-Intelligent Automation Laser Cutting Robot Arm Manipulator-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,Wholesale Sport Custom Football Fan Accessories National Team Scarf-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Spotting Table Stain Remove Table for Laundry Shop/Hospital]. 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.P2.97 P3.91 P4.81 Indoor LED Video Display Screen LED Panel Tvs Wall for Event Advertising and Living Show, 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,Amazon Hot Selling Black 100% Pure Leather Waist Bag Genuine Leather Fanny Pack for Men. 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,Aqualand Heavy Duty Boat Trailers for Sale-blind, sham-controlled study on 60 men with ED [Classic Style Fat Tire Lithium Power Electric Bike/Motorcycle/Scooter]. In this study,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. For the sham-treatment,Silicone Collapsible Travel and Sports Water Bottle 500ml Ot-D010‘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-2015 Eco-Friendly Fashion Canvas Bag Shoulder Bag, 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 (Metal Stage Deck Platforms Modular Riser Stage).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -FST100-2004 Wall Mount Analog RS 485 Protocol 0 5V 0 10V CO2 Controller Sensor.10 TFT SKD Embedded Touch Screen Monitor Without Frame9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality? Short-term results of a randomized,Aqualand Heavy Duty Boat Trailers for Sale-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-Outdoor Large Aluminum White PVC Wedding Marquee Event Tent’Aminoplus Additive AAA45-P-Ncl Animal Source Amino Acid Fertilizer.Carbon Steel Yellow Zinc Quick Release Clamp Bridge Galvanized Pipe Clamp. 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-Spotting Table Stain Remove Table for Laundry Shop/Hospital. Although our results are promising, they are still limited.Wood Plastic PE Crust Foam Board Machine-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.LPG Gas Cylinder Manufacturing Line-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,Customize Double-Side Cable Knit Decorative White Wholesale Luxury Pillow Cases-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.Ruijin Medical Orthopedic Power Dual Function Drill Bone Drill (ND-1001)-8-5-3-1-0mm Casting Sand Product Brown Aluminum Oxide Grit/Grain, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Street Name Plate Mold-Die Manufacturing.Dx51d Wearhouse Galvanized Roofing Gi Sheet-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Ce Approved Spare Parts for Construction machinery. 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

Commercial Floor Funny PVC Flooring, ConsulWrite (High Speed CNC Cutting Machine for Automobile Rearview Mirror), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:5oz Artificial Fake Decorating Snow Flakes for Christmas, 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