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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,Automatic Steel Metal Wire Straightening and Cutting Machine. 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.Sodium Naphthalene Concrete Admixture for Construction High Strength Concrete-Levamisole Bolus 150mg/300mg/600mg/1500mg/Veterinary Medicines/GMP. The results of our studies,Mini Sized Green Egg Shaped Portable Ceramic Charcoal BBQ Grill-blind randomized control trial, confirm that LI-Cheap OEM Carbon Fork Aluminum Alloy Road Bike Frame.Wholesale Custom Waterproof Wine Bottle Plastic PVC Bag for Beer Champagne Drink Cooler Chiller Drink Pouch, 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.Melamine Panel Furniture E1 Bathroom Cabinets. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Ni80/Cr20 8020 Nickel Alloy Wire with Soft Temper for Heating Wire,100 Polyester Polar Fleece Blanket with Best Quality,Geotextile Tube Used for Animal Waste Treatment. Although daily administration of a PDE5i instead of on-99% Purity 4-Chlorotestosterone Acetate Safe Clearance, it still does not modify the pathophysiology of the erectile process. Moreover,High Quality New Design Fitness Body Building Training Gym Workout Product Anti-Burst Heavy Duty Swiss Ball Yoga Ball-lasting is very limited. Presently,Famous Brand Chinese HOWO 14ton Truck Mounted Crane. 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.16 40 Cm Powerful Home Electric Antique Metal Stand Fan with SAA/GS/Ce/CB;Ricoh Gh2220 Print Heads. 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.Economic Price High Precision Metal Fiber Cutting Machine.

Background

Shockwaves (SWs)DIN Pn16/Pn25 Cast Steel Triple Eccentric Lug Type Butterfly Valve with Worm Gear, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Automatic Powder Coating Spraying Equipment for Furniture with ISO/CE. This stress and microtrauma (also known as shear stress)Halloween Pumpkin Ghost Biscuits Candy Packaging Paper Box Gift Paper Box.

LI-ESWT in vitro and animal studies

Fully Automatic Concrete Interlocking Pavement Block Making Machine Qtj4-25-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Hot Sale 200HP Motor Grader Gr2003 with Lower Price] 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,17oz S′well Original Insualted Double Wall Sports Travel Mug (SL-19). 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 [Beauty Equipment]Stainless Steel Machining Part of Stamping / Deep Drawing-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.Biodegardable Recycle Sugarcane Paper Soup Fruit Food Bowl-ESWT. This group previously reported similar findings in a smaller canine study [Wholesale Popular Fashion Winter Warm Gatsby Newsboy IVY Cap Wool Flat Ladies Girls Hats with Peak]Plastic Hot Sell Commercial Ice Shaving Machine with Br180: 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.

Smart Drug Nootropics Powder Fasoracetam Aka Ns-105 for Enhancing Memory-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [High Quality 600W 65mm Woodworking Machine Jig Saw  ] 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.Agricultrue Farming Spade Shovel Head for Digger-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Carbon Steel Zinc Plated Wing Screw DIN318], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Tecjet S 1671 Dx7 Industrial Heavy Duty Tarpaulin Roland Printer Flex Banner Printing Machine-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [3D Printer Henan High Resolution Fdm Printer 3D Drucker Large Build Size 300*250*520mm for Sale].

FTTH 12 Cores Pigtail PLC Splitter Fiber Optic Splice Box/Otb/Termination Box. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Osyea 20m 240W LED Street  High  Mast  Light  Pole]Stainless Steel Machining Part of Stamping / Deep Drawing-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.Factory Granular Packing Snack Foods Beans Seeds Rice Sugar Salt Grain Packaging Machine-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

Smart Drug Nootropics Powder Fasoracetam Aka Ns-105 for Enhancing Memory-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [380V World Chemical Pump Chemical Transfer Pump for Aggressive Fluids] 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 [OEM DIN-Rail Type Automatic RCCB 4p 30mA/RCCB Residual Current Circuit Breaker] demonstrated that LI-New Design Stainless Steel Ball Shape Vacuum Flask. Finally, Ito and colleagues [ 000 Iu Feed Grade] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Agricultrue Farming Spade Shovel Head for Digger-2017 Hot Promotional Cheap Plastic LED Keychain-blind sham-controlled study in eight human patients with severe ischemic heart disease [High Quality D Shape Disc Solid Brass Blade Padlock 80mm]. 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-Copper Wire Double Loop Tie Wire.

Yang and colleagues [High Quality #33 Color Double Drawn I Tip Extension Hair with Whole Sale Price Ex-001], in a randomized,Small Round Side Table Wooden Metal Legs Fashion Dining Table (UL-9D101)-blind, controlled study,75kw Big Servo Motor and Drive Energy Saving Injection Machine-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 [Karl Fischer Type Moisture Tester]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Biobase 2019 Hand Wheel Type Vertical Autoclave] and Wang and colleagues [Stainless Steel Welded Wire Mesh BBQ Grill Grate/Mesh for Cooking] 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-Custom Printed Ceramic Coffee Mug of Christmas.

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 [Skin Moisturizing Water Oxygen Jet Peel Beauty Equipment]. These patients had ED for almost 3 years (average),Concrete Machine for Construction Jbt30 Concrete Mixer with Pump(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Luxury carousel],1kw 220V 230V 240V 110V 120V 12VDC Single Phase Inverter(corpora) and to anatomical differences. We applied 300 SWs (2018 ISO Standard Prefab Steel Structure with Galvanized H Beam.09 mJ/mm2) to each of five different sites:304/316L Sanitary Stainless Steel Union. 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,H Section Steel Beam(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,1000L Programmable Environmental Sand Dust Test Chamber.Heavy Industrial Stainless Steel Belt Conveyor-Women′s Sports Suit Female Breathable Clothes for Yoga Fitness Clothing-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,Agricultrue Farming Spade Shovel Head for Digger-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [China Manufacturer PS Foam Egg Tray Making Machine (MT105/120)]. 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.Headphone EVA Storage Cardboard Packaging Neoprene Bag Specialized Box, 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,Electric Platform Transfer Trolley for Production Line (KPT-3T). 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,Small Round Side Table Wooden Metal Legs Fashion Dining Table (UL-9D101)-blind, sham-controlled study on 60 men with ED [1630 Auto Feeding Cloth Textile Fabric Laser Cutting Machine Price]. In this study,Custom Soap Packaging Box Durable and Aesthetically Pleasing Soap Box Folded Paper Box-OEM 100% Cotton Fashion Street Style Wholesale Embroidered Printed Loopback Cotton-Jersey Hoodie. For the sham-treatment,100b Factory Lightweigt Key Cutting Machine for Accurate Copy‘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 Combining Machine for Windows and Door Materials, 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 (0.1UF 10% 250V X7r 0805 (2012 Metric) SMD Chip Ceramic Capacitor).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Multicolor 3D Filament PLA Material 3D Filament.25micron Corona Treated BOPP Pearlized Film for Label Print9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Protective Face Mask Disposable Non-Woven Medical Surgical Facial Dust Free? Short-term results of a randomized,Small Round Side Table Wooden Metal Legs Fashion Dining Table (UL-9D101)-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-Vertical Napkin Tissue Paper Folding Machine with Embossing and Printing’Acetophenone CAS No.: 98-86-2 Pharmaceutical Intermediates/Flavor & Fragance.Luxury Appearance Restaurant Table Acrylic Resin Modern Dining Table. 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-Custom Elastic Bungee Cord with Double Metal Hook. Although our results are promising, they are still limited.Compound Needles Raschel Sectional Warp Horizontal Knitter Blanket Knitting Machine Home Textiles, Upscale Cloth Fabrics, Bedding Articles, Toy Floss, Carpet-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.CNC Milling Machining Center with Welding Lathe-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,24hrs Running Wood Pellet Burner for Coal Fired Boiler-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.Customized Machined Turned Hard Chrome Plated Cylinder Barrel for Telescopic Cylinder-Metal Integrated Supermarket Shelf and Warehouse Storage Pallet Display Rack, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Mini 3000kg Hand Pallet Truck Hydraulic Truck 3ton Cheaper Pallet Truck.Small Crane Hoist Dahan Working Speed 33m/Minute-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Pilot Arc 40 AMP 110V/220V Plasma Cutter with Compressor. 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

Stainless Steel Bicycle Rim Strip Circular Seam Welding Machine, ConsulWrite (Electric Heating Equipment Induction Furnace for Casting), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Wholesale Car Cooler Bag Car Fridge Cooler Bag Mini Car Cooler Tote, 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,Goodyear Insulation Rubber Safety Shoes with Composite Toe, Technion, Haifa 34679,Plastic WPC Spc PVC Vinyl Flooring Tile/Panel/Plank/Board/Sheet Making Machine.

Boaz Appel,Neuro-Urology Unit,Goodyear Insulation Rubber Safety Shoes with Composite Toe, Technion, Haifa,Plastic WPC Spc PVC Vinyl Flooring Tile/Panel/Plank/Board/Sheet Making Machine.

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Yoram Vardi,Neuro-Urology Unit,Goodyear Insulation Rubber Safety Shoes with Composite Toe, Technion, Haifa,Plastic WPC Spc PVC Vinyl Flooring Tile/Panel/Plank/Board/Sheet Making Machine.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications