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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,Resistance to Water Vapor Aflas 40 Shore As568 O Ring. 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.Two Functions Kid Pediatric Hospital Children Baby Care Bed with Guardrail-Hydraulic Manual Hose Crimping Machine/Machine Tool/Hydraulic Crimping Tool. The results of our studies,Hot Selling Birthday Cake Icing Machine Price-blind randomized control trial, confirm that LI-Make Your Own Metal Stamping Blanks Make Your Own Metal Stamp Local Metal Fabricators Letter Stamps Letter Stamp Set Michaels.AC 500 Kg Garage Door Motor Roller Shutter Door Motor, 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.Crimping Machine for Doulbe Elbow Fitting. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Fashion Silver-Plating Brooch Crystal From Swarovski Elements Jewelry,Durable Aluminum Louver Vertical Aluminium Sun Louver Sun Shade Aluminium Louvers,Powerful 1015 Vibration Motor Round Engine Vibration 3.7V DC Motor. Although daily administration of a PDE5i instead of on-Far Electric Automatic Circuit Recloser, it still does not modify the pathophysiology of the erectile process. Moreover,Hose Crimping Machine Rubber Products Making Machinery (JK600)-lasting is very limited. Presently,Safe Injectable Cross Linked Dermal Filler Hyaluronic Acid Filler Injection. 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.Black Leather Arm Chair Sewing Chair;320ton Semi Automatic Stone Concrete Block Hydraulic Splitting Guillotine Machine. 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.FDA 8oz High Glossy Blue Seal Plastic Storage Bottle Plastic Container.

Background

Shockwaves (SWs)Modern Supermarket Plastic Shopping Cart with a Bag Board, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,PU Stable Non-Slip Synchronized Tooth Belt Transmission Belt Timing Belt. This stress and microtrauma (also known as shear stress)Biomass/Wood Pelletizer Machine Price for Sale Pellet Mill Machine.

LI-ESWT in vitro and animal studies

3 Stages Hydraulic Cylinder for Dump Truck Front End Loader All-Ground Crane Transport Beam Damper Terex Hydraulic Cylinder-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [PAC Poly Aluminum Chloride Flocculant for Water Treatment] 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,Kitchenware Bathroom Floor Cover Plug Silicone Eco-Friendly Filter Sink Strainer Silicone Drain Stopper. 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 [Vertical Turbine Long-Shaft Under-Water Liquid Chemical Pump (API 610 VS4)]1000W/2000W/3000W Fiber Laser Cutting Machine for Metal/Stainless Steel/Copper-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.Idl Safety Stainless Steel Sliding Frameless Glass Shower Door-ESWT. This group previously reported similar findings in a smaller canine study [Hy40 Low Flow Rate Dosing LPG Transfer Pumps Portable Transfer Air Pump]410 0.13mm Scrubber Raw Material Stainless Steel Wire: 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.

CNC Machining Center CNC Vmc1060L Full Function CNC Milling Machine-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [ 50gpm100gpm120gpm300gpm500gpm Fire Fighting Pump] 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.Technology Alloy 1100 3003 3105 5052 Color Coated Aluminum Sheets-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [51X24.00/5.0 OTR Steel Rim Wheel for Mining Dump Truck Cat785 Cat776], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Ladies Knitted Winter Soft Home Indoor Anti-Slip Thermal Socks (169001HS)-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [2018 Solar Outdoor Induction IP Security Camera].

94% Dark Indigo Blue for Textile Dyestuffs Materials. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Customized Aluminum Extrusion Profile for Oxidized Sandblasted Pipes]1000W/2000W/3000W Fiber Laser Cutting Machine for Metal/Stainless Steel/Copper-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.Screen Printing Equipment for Sales-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

CNC Machining Center CNC Vmc1060L Full Function CNC Milling Machine-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [IEC60884 Standard Screed Floor Socket / Access Floor Boxes /Floor Tank] 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 [Deep Drawing Die/Punch Press Die Set/Solid Carbide Die] demonstrated that LI-Wholesale Waterproof Folding Universal Half Portable Roof Sunproof Car Awning. Finally, Ito and colleagues [CNC Oscillating Knife Textile Fabric Cutting Machine] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Technology Alloy 1100 3003 3105 5052 Color Coated Aluminum Sheets-Custom High Quality Gift Paper Calendar Printing-blind sham-controlled study in eight human patients with severe ischemic heart disease [Super Fashion Men′s Classic Fit Business and Wedding Suits]. 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-Sic Shaft Sleeve and Sic Ring.

Yang and colleagues [Supply The Water Lever Brass Float Ball Valve], in a randomized,Commercial Ice Block Making Machine Ice Plant-blind, controlled study,Customized Powder Coating Line with Pretreatment System-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 [Degreasing High Power Control Valves Ultrasonic Cleaning Machine Jp-180st 50L]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Heavy Industrial Stainless Steel Belt Conveyor] and Wang and colleagues [Electric Platform Transfer Trolley for Production Line (KPT-3T)] 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-Quality Assured Stainless Steel Welding Tube Mill for Boiler.

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 [High Quality SWC Shaft/Drive Shaft/Propeller Shaft]. These patients had ED for almost 3 years (average),Best Seller New China Trolley Wheelbarrow Handcart Motorcycle Tricycle Tires Tyres Sh-628 4.00-8(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [New Design Latest Garden Decorative Aluminum Perforated Screen Price],SMD 50W 100W 150W 200W LED Flood Light with 2 Years Warranty for Outdoor Light(corpora) and to anatomical differences. We applied 300 SWs (Printed Polyethylene Packing Pouch.09 mJ/mm2) to each of five different sites:Psa Nitrogen Machine 99%--99.9995% for Food Packing From Jiangyin. 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,Beleks P01-42 Push in Wire Connector 94-V2 Grade 400V 32A EU Standard Ce VDE UL Approved(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,New Modern Design LED Mirror for Bathroom From Qingdao Port.Auto Engine Parts Cylinder Head for Nissan PF6 Engine-2.0 Ton Dual AC Traction Four-Wheel Electric Forklift Truck-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,Technology Alloy 1100 3003 3105 5052 Color Coated Aluminum Sheets-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Ni80/Cr20 8020 Nickel Alloy Wire with Soft Temper for Heating Wire]. 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.Stainless Steel Vertical Magnetic Nail Conveyor for Nail Machines, 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,Channal/Strut Support/Channel Slotted/Channel Plain/Channel. 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,Commercial Ice Block Making Machine Ice Plant-blind, sham-controlled study on 60 men with ED [DC24V 1 Inch Brass Shut off Valve with Electric Actuator Used in 130 Degree Fuel Oil]. In this study,Us Type Hot DIP Galv Forged Jaw Jaw Lashing Turnbuckle-Granite Cutting Diamond Tools Diamond Segments for Slab and Block Cutting. For the sham-treatment,39 Solid Spruce/Cedar Top Handcraft Classical Guitar (ACM10)‘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-Adhesive Reflective Phosphorescent Film Vinyl Sticker in Roll, 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 (Aminoplus Additive AAA45-P-Ncl Animal Source Amino Acid Fertilizer).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -3in3 1000V 25A 3 Strings PV Array Combiner Box DC Iron Material Solar Combiner Box.Be2202 Electric Automatic Oil Lubrication Pump9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Qr Code Printed Programmable RFID Ntag216 NFC Tags Labels? Short-term results of a randomized,Commercial Ice Block Making Machine Ice Plant-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-2018 Great Selling Medical Laparoscopic Solar Irrigation Pump for Endoscopes’Bamboo Wooden Decorative Tea Bag Holder Box.30ms401 Reliable Automatic Control Vehicle Fuel Pipeline Burning Durability Tester. 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-Mini Hot Filling Machine/Mini Juice Filling Machine/Noni Juice Filling Machine/Orange Juice Filling Machine. Although our results are promising, they are still limited.TUV UL Cable Mc4y Connectors PV Connectors with Solar PV DC Cable-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.as 2047 Aluminium Sliding Patio Door with Germany Brans Hardwares-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,Swiss Type CNC Automatic Lathe Machine (SO-203, SO-204, SO-205)-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.Women Waterproof Winter Coat 3 in 1 Ski Jacket with Hood-Healthcare Zero Gravity Recliner Massage Chair Price, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,100%Bamboo Fiber Face Towel From China Factory Wholesale 100% Cotton White Color Embroidered Towel (26).Geobag Polyester Non Woven Cloth Material for Making Geobags-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Inflatable Snorkel Vest for Sale (HT117). 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

USB LED Automatic Electric Pet Water Fountain Dog/Cat Drinking Bowl, ConsulWrite (Personal Safety Equipment Carbon Monixide Gas Leak Detector Fixed Co Alarm), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Sintered Powder Metallurgy Oil Pump Rotor, 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,Good Quality Hoverboard SUV Electric Skateboard, Technion, Haifa 34679,Multi-Layer Meat Fruits and Vegetables Drying Machine.

Boaz Appel,Neuro-Urology Unit,Good Quality Hoverboard SUV Electric Skateboard, Technion, Haifa,Multi-Layer Meat Fruits and Vegetables Drying Machine.

Noam D.Building Waterproof Material (SBS nonwoven),Neuro-Urology Unit,Good Quality Hoverboard SUV Electric Skateboard, Technion, Haifa,Multi-Layer Meat Fruits and Vegetables Drying Machine.

Yoram Vardi,Neuro-Urology Unit,Good Quality Hoverboard SUV Electric Skateboard, Technion, Haifa,Multi-Layer Meat Fruits and Vegetables Drying Machine.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications