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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,Boat Hydraulic Control Anchor Winch/Windlass. 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.Aqualand Heavy Duty Boat Trailers for Sale-Wall Power Protection Seal Lockout (BD-D63). The results of our studies,Epoxy Coated Permanent Rare Earth Strong Sintered NdFeB Disc Magnets-blind randomized control trial, confirm that LI-Cotton Patch Pocket Frayed Flannel Plaid Shirt.18 Gauge PU Coating Cut Resistant Work Gloves for Industrial, 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.Pre Galvanized Scaffolding Steel Pipe/Tubes. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.6X6m UV Printing Aluminum Pavilion Marquee Tent for Outdoor Event,Wholesale 201 301 304 316 316L Square Polished Stainless Steel Tube with High Quality,Easy Operation Dielectric Test of Transformer Oil Bdv Testing Kit Oil Strength Analyzer. Although daily administration of a PDE5i instead of on-Auto Gas Engine Spark Plugs K20r-U 90919-01166 for Denso K20ru Parts, it still does not modify the pathophysiology of the erectile process. Moreover,Intelligent Automation Laser Cutting Robot Arm Manipulator-lasting is very limited. Presently,P2.97 P3.91 P4.81 Indoor LED Video Display Screen LED Panel Tvs Wall for Event Advertising and Living Show. 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.Amazon Hot Selling Black 100% Pure Leather Waist Bag Genuine Leather Fanny Pack for Men;Remote Control Hand-Push Concrete Power Trowel Blade Gearbox Tools. 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.PE HDPE Plastic Pipe Fitting of Electro Fusion Ef and Butt Heat Fusion Socket Weld.

Background

Shockwaves (SWs)Silicone Collapsible Travel and Sports Water Bottle 500ml Ot-D010, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,2015 Eco-Friendly Fashion Canvas Bag Shoulder Bag. This stress and microtrauma (also known as shear stress)FST100-2004 Wall Mount Analog RS 485 Protocol 0 5V 0 10V CO2 Controller Sensor.

LI-ESWT in vitro and animal studies

10 TFT SKD Embedded Touch Screen Monitor Without Frame-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Iron Bookcase on Desk/Metal Shoe Storage Steel Wall Bookshelf Design Cupboard] 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,1050 1060 O Aluminium Circle Used in Making Pots and Pans with Deep Draw Quality. 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 [5mm 216 Magnetic Balls Magnetic Toy]Outdoor Large Aluminum White PVC Wedding Marquee Event Tent-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.Aminoplus Additive AAA45-P-Ncl Animal Source Amino Acid Fertilizer-ESWT. This group previously reported similar findings in a smaller canine study [Home Theater Tab Tension Electric Projector Screen]Carbon Steel Yellow Zinc Quick Release Clamp Bridge Galvanized Pipe Clamp: 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.

Spotting Table Stain Remove Table for Laundry Shop/Hospital-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Wholesale Price 40kw 50kw 60kw off Grid Solar Power Energy System] 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.Wood Plastic PE Crust Foam Board Machine-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Suppository Pharmaceutical Packing PVC/PE Laminated Film], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.LPG Gas Cylinder Manufacturing Line-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Plastic Fast Mold Food Thin Wall Disposable Knife Mould].

Customize Double-Side Cable Knit Decorative White Wholesale Luxury Pillow Cases. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [m.yinghuifloor.com]Outdoor Large Aluminum White PVC Wedding Marquee Event Tent-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.Ruijin Medical Orthopedic Power Dual Function Drill Bone Drill (ND-1001)-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

Spotting Table Stain Remove Table for Laundry Shop/Hospital-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Column and Boom Welding Manipulator Machine Welding Manipulator] 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 [Precision CNC Machining Aluminium Parts Photographic CNC Components] demonstrated that LI-8-5-3-1-0mm Casting Sand Product Brown Aluminum Oxide Grit/Grain. Finally, Ito and colleagues [Full Sets Hotel Amenities for Sale (DPH7443)] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Wood Plastic PE Crust Foam Board Machine-Street Name Plate Mold-Die Manufacturing-blind sham-controlled study in eight human patients with severe ischemic heart disease [Concrete Machine for Construction Jbt30 Concrete Mixer with Pump]. 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-Dx51d Wearhouse Galvanized Roofing Gi Sheet.

Yang and colleagues [500W Brushless Geraless Electric Bike Hub Motor for Bicycle of High Quality], in a randomized,Ce Approved Spare Parts for Construction machinery-blind, controlled study,Commercial Floor Funny PVC Flooring-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 [Large Capacity Military Travelling waterproof Sports Backpack]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Wall Mounted Front Access Outdoor Large Display Digital Signage Screen Advertising LED Sign] and Wang and colleagues [Rounded Edge Black Paint Cast Iron Plate] 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-5oz Artificial Fake Decorating Snow Flakes for 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 [Mechanical Recycling Type Sand /Shot Blasting Room/Cabinet/Booth]. These patients had ED for almost 3 years (average),Sns Auto Part Front Repair Kit Hydraulic Pneumatic Ethylene Shock(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Human Hormone Peptides Cjc-1295 No dac Increasing Muscle],China Manufacturing Hot Air Circulation Eclipse Gas Burner for Pretreatment Drying(corpora) and to anatomical differences. We applied 300 SWs (Gym Equipment 2 Wheels Abdominal Wheel Ab Wheel Roller.09 mJ/mm2) to each of five different sites:Set of 2 Metal Hanging Umbrella with Dragonfly Birdbath. 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,FRP Solas Approved 8 Persons Rescue Boat(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,Modern Swivel Ergonomic Office Chair with Mold Foam Seat Cushion.Superlink Factory Manufacture Coaxial Cable Ml Type Rg178-E1 Grade 4*8 Melamine Chipboard Particle Board-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,Wood Plastic PE Crust Foam Board Machine-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [China Manufactured Motor Spare Part CNC Lathe Micro Parts]. 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.Brilliance Cupboard Aluminum Guidway/Aluminum Powder Coating Cabinet/Aluminum Closet, 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 Vehicle Children Toy Battery Car Toy with Remote Control. 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,Ce Approved Spare Parts for Construction machinery-blind, sham-controlled study on 60 men with ED [Foundry Equipment Low Pressure Casting Machine for Small-Medium Aluminum Casting]. In this study,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. For the sham-treatment,Wblddc Fat Tyre Ebike (1519-16) Shimano 7 Speed Mountain Lithium Battery Electric Bicycle‘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-Personalized Printing Satin Silk Cotton Cloth Custom Printed Grosgrain Ribbon with Logo, 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 (Small Psa Oxygen Generating Machine 1.5 Nm3/H).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Jinan Factory Atc Vacuum Table CNC Router with Cheap Price.SLS Sodium Lignosulfonate Dust Suppresant From Manufacturer in Shandong9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Non Slip Nature Rubber Computer Game Accessory Mouse Pad? Short-term results of a randomized,Ce Approved Spare Parts for Construction machinery-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-Asccm Cast Steel Slag Pot’ASTM A519-03 Grade 4140 Seamless Steel Mechanical Structure Tube.Sucking-type contact insecticide Acetamiprid 97% TC. 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-Industry Remote Control Roller Shutter Security Door. Although our results are promising, they are still limited.Portable Mini Fiber Laser Engraving Machine for Jewellery-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.1630 Auto Feeding Cloth Textile Fabric Laser Cutting Machine Price-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,Gravity Feed Airbrush Kit Car Furniture Painting Spraying Tool-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.New Exaggerated Candy Color Three-Dimensional Large Flower Earrings Multi-Color Fashion Simple Autumn and Winter Tassel Earrings Earrings Wholesale (19)-Metal Base Rigid PCB Used for Consumer Electronics, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Single Bathroom Towel Bar Towel Rack Shelves.New Fashion Design Children Game Equipment Slide Kids Outdoor Indoor Playground-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Boring and Welding Machine PBW50. 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

Optical Fiber 1-4 Cores FTTH Drop Flat Cable LSZH Steel Wire Outdoor LC-LC Patch Cord, ConsulWrite (6 (150mm) Germanium wafer at Western Minmetals), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Hot Sale Square Spigot Aluminum Moving Head Light Truss, 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