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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,LED Touch Desk Lamp with Bluetooth Speaker. 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.2019 New Underwater Lifesaving Wristband/ Swimming Inflating Lifesaving Bracelet-Portable Home IPL Elight Hair Removal and RF Wrinkle Removal 2 in 1 Mulifunctional Beauty Salon Equipment. The results of our studies,Bespoke Printed Handbags Paper Bag Takeaway Food Packaging Handle Bag-blind randomized control trial, confirm that LI-305m Per Roll UTP Cat5e LAN Cable.Shanghai Electroplating Thermform LED Lighten Car Logo, 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.Customized Precision High Quality CNC Turning Aluminum Control Pointer Knob. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Perfect Design GB Material Welded Structural Stee,Hydraulic Scissor Lift Table Woodworking Machine,Cement Tank Transport Truck Trailer for Sale. Although daily administration of a PDE5i instead of on-Zp-5A Pharmaceutical High Speed Automatic Rotary Tablet Press, Punch Press, Pill Press, it still does not modify the pathophysiology of the erectile process. Moreover,Self Adhesive Silicone Double Sided Tape Silicone Tape Water Proof Rubber Tape-lasting is very limited. Presently,High Quality LED 200W Soft Fresnel Profile Light DJ Equipment. 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.0.2um 0.45 Micron PTFE Pleated Filter Cartridge for Pharmaceuticals and Chemicals;Gasoline Concrete Finishing Walk-Behind/Edging Power Trowel Gyp-442. 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.Production Lines Machine for Hemodialysis Equipment and Kidney Dialysis Disposables.

Background

Shockwaves (SWs)Exterior Waterproof Decorative PVC Wall Panel, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Brick Making Machine Cement Qt4-20 Eco Brick Machine. This stress and microtrauma (also known as shear stress)Diamond Shape Portable Galvanzied Chain Link Fence.

LI-ESWT in vitro and animal studies

Customzied Rubber Sealing Design by EPDM/Silicone/NBR/FKM/Viton-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Customized Design Hotel Men Bathrobe Microfiber] 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,Galvanized Powder Coated Anti-Climb Anti-Cut 358 Security Mesh Fence. 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 [Corner Crimping Machine]Ht-0764 Biohazard Transport Bag-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.PP Crude Steel Wire Like Organic Macro Polypropylene Fiber-ESWT. This group previously reported similar findings in a smaller canine study [Portable Source Conductive Spring Sheet]2017 New High Quality Ferrite Segment Magnet for Industrial Use: 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.

Neon Color Decal Printing Shot Glass-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Sky Zone Supplier for Adult Big Indoor Trampoline Park with Climbing Walls] 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.Conveyor Belt Type Edge Gluer Board Press with High Frequency Technology-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Household Desiccant Calcium Chloride with Reach Registration], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.2500W 6000W High Precision Fiber Sheet Metal Laser Cutting Machine Price for Iron, Copper, Steel Plate Laser Cutting Machines-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [P8 Full Color Outdoor Advertise Big Curved LED TV Screen].

China Manufacturer Customized Food Grade Silicone Rubber Products Silicone Kitchen Utensils. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [MTP Attenuators]Ht-0764 Biohazard Transport Bag-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.Qby Double Membrane Diaphragm Pump-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

Neon Color Decal Printing Shot Glass-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [En124 D400 Ductile Cast Iron Ductile Iron Sewer Round Manhole/Drain/Driveway Drain/Access Cover] 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 [Auto Parts Repair Kit 04445-35120 for Toyota Hilux Ln145] demonstrated that LI-Industral Grade Sodium Gluconate Used for Concrete Retarder. Finally, Ito and colleagues [Soft Cotton Baby Swaddle Blanket Sheep Printed] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Conveyor Belt Type Edge Gluer Board Press with High Frequency Technology-Plastic PVC/UPVC Two Cavities Pipe/Tube/Hose Extrusion Production Line-blind sham-controlled study in eight human patients with severe ischemic heart disease [Hot Sale Party Picnic White Padded Resin Folding Chair (XYM-R01)]. 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-High Effective Reinforced 125mm Abrasive Disc/Cut off Wheel.

Yang and colleagues [High Quality Automatic Screen Printing Machine], in a randomized,Sunshine Polypropylene Non Woven Fabric for Pillow Cover-blind, controlled study,Latest Mini Portable I8X Tws Stereo Earbuds Wireless Afans Earphones for Apple iPhone X-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 [Factory Automotive Medical Equivalent Compatible 4pin Redels Plastic Connector]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Stainless Steel Sintered Filter Tube14] and Wang and colleagues [Waterproof Ultra Thin Digital Signage Kiosk Advertising Display IPS LCD] 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-Besen 10/16A Charger Portable EV Charging Box with Type 2 Plug Cee Outlet Standard.

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 [Vq Series Speed and Pressure Intra-Vane Pump]. These patients had ED for almost 3 years (average),High Speed Lead Screw Tr6X12 for 3D Printer(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [High Rate Plastic Material Swimming Pool Sand Filter with Pump],Hotsale Price Living Room Wedding Dining Outdoor Auditorium Banquet Chair(corpora) and to anatomical differences. We applied 300 SWs (125ml Wholesale Reed Diffuser in Color Box Home Fragrance Bottle.09 mJ/mm2) to each of five different sites:1400 High Temperature Vacuum Sintering Tube Furnace Rotary Tube Furnace. 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,3′x5′ NHL Hockey Team NFL Team Collegiate Ncaa Sports Flags(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,1200mAh Silicone Fabric Round Portable Waterproof Wireless Bluetooth Speaker.50-500um Milk White Film for Solar Cell Backsheets (CY25R)-8862 Aluminium Alloy Camping Torch 10W T6 Tactical Flashlight-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,Conveyor Belt Type Edge Gluer Board Press with High Frequency Technology-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Customized Cotter Pins Fastener DIN94]. 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.Goldensign Laser Cutting Machine GS1490 with 60W CO2 Glass Laser Tube, 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,Metal Stamped Bending Machining Parts. 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,Sunshine Polypropylene Non Woven Fabric for Pillow Cover-blind, sham-controlled study on 60 men with ED [Instant Noodle Box Heat Shrink Packing Machine]. In this study,Hot Sale Steel Shoe Rack Shelving/Stable Warehouse Boltless Racks/Cheap Light-Duty Warehouse Rack-Factory Directly Sell Iron and Metal Hotel Banquet Chair Home Aluminium Dining Chair Church Chair. For the sham-treatment,Clear Acrylic Makeup Organizer for Puff Cake Palette‘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-Best Price Forming Spring Wire Bending 3 Axis CNC Spring Making Machine, 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 (Fleece Blanket with Nylon Handle with Customized Logo).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -White/Yellow/Brown/Black/Grey Light Emperador Marble Bathroom Vanity Top for Hotel/Kitchen/Granite/Quartz.High Quality Lady Wool Cashmere Knit Blanket Winter Scarf9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)High Pressure Sodium Light Tower Lifting System 20m High Mast? Short-term results of a randomized,Sunshine Polypropylene Non Woven Fabric for Pillow Cover-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-Metal Bond Trapezoid Diamond Abrasive Disc for Concrete/Stone Grinding’Neoprene Knitted Compression Patellar Knee Pads for Support and Flexibility.Plastic Roof Cover/Water Proof Sound Insulation Plastic Hollow Structure Roofing. 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-Steel Chrome Plated Dual Bent Pin Combo Hitch Receiver Lock. Although our results are promising, they are still limited.Green/Blue Glass Bottle-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.NFC magnetic strip hotel key PVC blank smart RFID card-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,New Floor Materials Outdoor Flooring DIY Easy Install and Colorful Durable Safety Rubbrer Tiles-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.Recycled Blue HDPE Heavy Duty Small Plastic Pallets for Free-Inflatable Arch for Advertising Inflatables, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,60kw Windmill / Pitch Controlled Wind Turbine /Wind Power Generator.Rechargeable LED Lighted Makeup Mirror for Home Bathroom Travel-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Skin Moisturizing Water Oxygen Jet Peel Beauty Equipment. 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

Customized Metal Steel Wire Wine Floor Exhibition Book Retail Shop Supermarket Bike Clothes Shoe Vegetable Store Tile Display Stand Shelf Rack, ConsulWrite (m.excavatorfilters.com), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Guangzhou Nails Polish Wholesale Nail Salon Equipment Nail Drill Machine, 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

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References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications