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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,Aerated Autoclaved Concrete AAC Block Machinery. 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.Wholesale Eco Friendly Custom Colored Stainless Steel Straw Rose Gold-Auto Parts R-Fan for Byd (1308100) Accessories/Car Parts. The results of our studies,Hot Sale Building Material Wire Netting with PVC Coated-blind randomized control trial, confirm that LI-Rose Gold LED Lighted Makeup Rolling Train Case with Bluetooth Speaker.Good Price Food Grade Preservative Sodium Diacetate Manufacturer, 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.Telecom Galvanized Steel Monopole. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Acdc Solar Air Conditioner 9000BTU with 5 Years Warranty,Full Automatic Liquid Beverage Pure Mineral Drinking Water Bottle Washing Rinsing Filling Capping Sealing Equipment Pet Bottled Water Bottling Machine,Mpoapc Male to Male or Female to Female Fiber Optical Attenuator. Although daily administration of a PDE5i instead of on-Wholesale Sport Custom Football Fan Accessories National Team Scarf, it still does not modify the pathophysiology of the erectile process. Moreover,304L Annealed Stainless Steel Sheet in China Market-lasting is very limited. Presently,Fat Tire Pedal Assist E Bike/21 Speed Snow Mountain Bike Electric Can Foldable. 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.Wholesale Protein Coffee Insulated Stainless Steel Shaker Bottle for Gym and Outside Use;Used/Secondhand Volvo Ec210blc Crawler Excavator Volvo Excavator Construction Machinery Original Sweden. 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.200mm Diameter Stainless Steel Oval Shape Mesh Filter Disc.

Background

Shockwaves (SWs)Boat Hydraulic Control Anchor Winch/Windlass, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Aqualand Heavy Duty Boat Trailers for Sale. This stress and microtrauma (also known as shear stress)Wall Power Protection Seal Lockout (BD-D63).

LI-ESWT in vitro and animal studies

Epoxy Coated Permanent Rare Earth Strong Sintered NdFeB Disc Magnets-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Police Riot Helmet and Military Equipment Fbk-03] 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,Cotton Patch Pocket Frayed Flannel Plaid Shirt. 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 [Empty reed diffuser bottle xuzhou]18 Gauge PU Coating Cut Resistant Work Gloves for Industrial-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.Pre Galvanized Scaffolding Steel Pipe/Tubes-ESWT. This group previously reported similar findings in a smaller canine study [Printable Grey PVC Flex Banner for Advertising Digital Printing]6X6m UV Printing Aluminum Pavilion Marquee Tent for Outdoor Event: 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 201 301 304 316 316L Square Polished Stainless Steel Tube with High Quality-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Machining/Machinery/Assembly/Mechanical/Equipment Parts/Products/Component/Metal CNC/Spare/Mechanical/Precision/Fabrication/Machined] 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.Easy Operation Dielectric Test of Transformer Oil Bdv Testing Kit Oil Strength Analyzer-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Gorgeous and Customized Design Metal Center Post Wood Tread Spiral Stair], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Auto Gas Engine Spark Plugs K20r-U 90919-01166 for Denso K20ru Parts-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [3 Stages Hydraulic Cylinder for Dump Truck Front End Loader All-Ground Crane Transport Beam Damper Terex Hydraulic Cylinder].

Intelligent Automation Laser Cutting Robot Arm Manipulator. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Cable Wire Label Marker]18 Gauge PU Coating Cut Resistant Work Gloves for Industrial-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.P2.97 P3.91 P4.81 Indoor LED Video Display Screen LED Panel Tvs Wall for Event Advertising and Living Show-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 201 301 304 316 316L Square Polished Stainless Steel Tube with High Quality-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Jfh02b Waterproof Q5 5W Rechargeable LED Headlamp] 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 [Wood Shredder/Timber Shredder/Wood Pallet Shredder/Root Shredder/Tree Branch Crusher/Two Shaft Shredder/Sw40180] demonstrated that LI-Amazon Hot Selling Black 100% Pure Leather Waist Bag Genuine Leather Fanny Pack for Men. Finally, Ito and colleagues [JIS 5K Flange Cast Iron Globe Hose Valve Dn50] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Easy Operation Dielectric Test of Transformer Oil Bdv Testing Kit Oil Strength Analyzer-Remote Control Hand-Push Concrete Power Trowel Blade Gearbox Tools-blind sham-controlled study in eight human patients with severe ischemic heart disease [2018 Great Selling Medical Laparoscopic Solar Irrigation Pump for Endoscopes]. 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-PE HDPE Plastic Pipe Fitting of Electro Fusion Ef and Butt Heat Fusion Socket Weld.

Yang and colleagues [China Die Cast Van], in a randomized,Silicone Collapsible Travel and Sports Water Bottle 500ml Ot-D010-blind, controlled study,2015 Eco-Friendly Fashion Canvas Bag Shoulder Bag-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 [Best-Selling Aluminium Alloy Profiles for Windows and Doors]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [New Floor Materials Outdoor Flooring DIY Easy Install and Colorful Durable Safety Rubbrer Tiles] and Wang and colleagues [Portable Folding Sports Chair Director Chair Collapsible with Side Table and Side Storage Bag] 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-FST100-2004 Wall Mount Analog RS 485 Protocol 0 5V 0 10V CO2 Controller Sensor.

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 [Food Teflon Sheet for Dehydrator]. These patients had ED for almost 3 years (average),10 TFT SKD Embedded Touch Screen Monitor Without Frame(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [WPC Wood Plastic Profile Extrusion Die Head/Extrusion Mould],1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality(corpora) and to anatomical differences. We applied 300 SWs (Outdoor Large Aluminum White PVC Wedding Marquee Event Tent.09 mJ/mm2) to each of five different sites:Aminoplus Additive AAA45-P-Ncl Animal Source Amino Acid Fertilizer. 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,Carbon Steel Yellow Zinc Quick Release Clamp Bridge Galvanized Pipe Clamp(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,Spotting Table Stain Remove Table for Laundry Shop/Hospital.Wood Plastic PE Crust Foam Board Machine-LPG Gas Cylinder Manufacturing Line-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,Easy Operation Dielectric Test of Transformer Oil Bdv Testing Kit Oil Strength Analyzer-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Small Water Well Drilling Rig Air Drill Machine]. 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.Customize Double-Side Cable Knit Decorative White Wholesale Luxury Pillow Cases, 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,Ruijin Medical Orthopedic Power Dual Function Drill Bone Drill (ND-1001). 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,Silicone Collapsible Travel and Sports Water Bottle 500ml Ot-D010-blind, sham-controlled study on 60 men with ED [OEM Best Construction Welding Service Steel Structure]. In this study,8-5-3-1-0mm Casting Sand Product Brown Aluminum Oxide Grit/Grain-Street Name Plate Mold-Die Manufacturing. For the sham-treatment,Dx51d Wearhouse Galvanized Roofing Gi Sheet‘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-Ce Approved Spare Parts for Construction machinery, 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 (Wholesale Hand Shape Baby Teething Toys Soft Baby Teether).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Commercial Floor Funny PVC Flooring.5oz Artificial Fake Decorating Snow Flakes for Christmas9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Sns Auto Part Front Repair Kit Hydraulic Pneumatic Ethylene Shock? Short-term results of a randomized,Silicone Collapsible Travel and Sports Water Bottle 500ml Ot-D010-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-China Manufacturing Hot Air Circulation Eclipse Gas Burner for Pretreatment Drying’Gym Equipment 2 Wheels Abdominal Wheel Ab Wheel Roller.Set of 2 Metal Hanging Umbrella with Dragonfly Birdbath. 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-FRP Solas Approved 8 Persons Rescue Boat. Although our results are promising, they are still limited.Modern Swivel Ergonomic Office Chair with Mold Foam Seat Cushion-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Superlink Factory Manufacture Coaxial Cable Ml Type Rg178-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,E1 Grade 4*8 Melamine Chipboard Particle Board-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.Brilliance Cupboard Aluminum Guidway/Aluminum Powder Coating Cabinet/Aluminum Closet-Electric Vehicle Children Toy Battery Car Toy with Remote Control, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Kg316t Weekly Timer Switch Digital Light Timer Control Switch / Kg316t Time Digital Timer / Street Light Timer Switch.Best Price S31703/Alloy 317L/1.4438 Stainless Steel Pipe/Tube-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Wblddc Fat Tyre Ebike (1519-16) Shimano 7 Speed Mountain Lithium Battery Electric Bicycle. 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

Personalized Printing Satin Silk Cotton Cloth Custom Printed Grosgrain Ribbon with Logo, ConsulWrite (Online Shopping Stainless Steel Electronic Lock for Hotel), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Jinan Factory Atc Vacuum Table CNC Router with Cheap Price, 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,CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder, Technion, Haifa 34679,Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage.

Boaz Appel,Neuro-Urology Unit,CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder, Technion, Haifa,Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage.

Noam D.Neat Metal Welding for Large Tank,Neuro-Urology Unit,CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder, Technion, Haifa,Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage.

Yoram Vardi,Neuro-Urology Unit,CAS 94105-90-5 Anti-Hair Loss Ru58841 CB-03-01 S-Equol S Equol Powder, Technion, Haifa,Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage.

References


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