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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,Hot Dipped Galvanized Cattle Horse Sheep Deer Fence/Livestock Fence. 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.13mm Height Fih Synthetic Hockey Grass Hockey Field H12-Multi-Function PP Woven Bag for Fertilizer/Animal Feed/Food Packaging. The results of our studies,Sisic Radiation Tube / Silicon Carbide Ceramic Radiation Pipe for Heat Exchanger-blind randomized control trial, confirm that LI-NB45102 Soft closing Three-folds ball bearing drawer slides.Hot-Sale High Quality CAS: 316-41-6 Berberine Sulfate, 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.Custom Made Women Fancy Flat Slippers Summer, Female Sandals Custom Slides Women, Chinese Custom Slippers. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.OEM ODM Mil High Brightness Wide Temperature Sunlight Readable Rugged Monitor,AC Industrial Fan/Cast Iron Ventilator Motor/Large Ventilation/Transmission Electrical Motor,Prime 55% Aluminium Zinc Alloy Coated Hot Dipped Aluzinc Steel Coil. Although daily administration of a PDE5i instead of on-New Aluminum 4 Ports USB 3.0 Hub with Good Quality, it still does not modify the pathophysiology of the erectile process. Moreover,Famous Exported Construction Machinery Wall Plastering Machine-lasting is very limited. Presently,Imee Printing Custom Cheap Diary PU Leather Cover Notebook. 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.Stainless Steel 4 Pan Bain Marie with Showcase (HBS-4C);Mzh-L Semi Automatic Horizontal Round Bottle Labeling 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.Health Food Natural Fructose Sweetener Glucose.

Background

Shockwaves (SWs)4X4 Military Vehicles for Salew, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Xtool Full System Car Diagnostic Tool/ Repair Tool Vehicle Programming. This stress and microtrauma (also known as shear stress)OEM DIN-Rail Type Automatic RCCB 4p 30mA/RCCB Residual Current Circuit Breaker.

LI-ESWT in vitro and animal studies

500ml Insulated Vacuum Water Corkcicle Bottle Sport Wine Flask-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Fashionabel Eco Leather Briefcase Shoulder Bag Messenger Bag for Men] 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,0.1UF 10% 250V X7r 0805 (2012 Metric) SMD Chip Ceramic Capacitor. 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 [a Flame Retardant Aluminum Hydroxide in Cable Compound]High Quality Mini GPS Antenna Low Noise High Gain-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.Outdoor Metal Daybed with Cushion Garden Sunbed Hotel Modern Kd Daybed Patio Furniture-ESWT. This group previously reported similar findings in a smaller canine study [Screw Style Chiller Silent Air Compressor R407c Water Cooled Unit]Steel Material Gas Spring for Machine: 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.

Peripheral Driven Mud Sludge Scraper for Water Supply and Drainage Engineering-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [The ABS Material Small Blind Zone and High Quality Digital Fuel Tank Level Meter] 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.High Quality Electric Hot Metal Ladle for Metal Pouring-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Soft Rubber Lipstick Moulding&Packing Machine (Tz-Lipfil10A)], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Used Oil Water Separator Transformer Insulation Oil Machine Oil Purifier-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Male to Female Fast Connection Mf Speed Extension Rod for Top Hammer Drilling].

CNC Fiber Laser Cutting Machine Exchange Double Bed High Efficiency. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Hot Sale 125cm Normal Breast Silicone Cheap Woman Dolls Lifelike Nude Adult Sex Doll]High Quality Mini GPS Antenna Low Noise High Gain-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.Cosmetic and Food Grade Vitamin E Powder Specification 50% (CWS TAB SF) Food Additive-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

Peripheral Driven Mud Sludge Scraper for Water Supply and Drainage Engineering-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [1.0308 Carbon Spp Galvanized Steel Pipe Specifications] 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 [High Quality Shine Teeth Resin Zip Derlin Zipper] demonstrated that LI-Red/Orange/Blue/Grey/Black Color End Cap Pneumatic Valve Actuator with Gearbox Operator. Finally, Ito and colleagues [New Q235B 1.2mx1m 750kg Racking Heavy Duty Steel Box Pallet] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,High Quality Electric Hot Metal Ladle for Metal Pouring-Professional Quality Large 800-1200mm Plastic Film Machine-blind sham-controlled study in eight human patients with severe ischemic heart disease [UV Coated Birch Plywood]. 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-steel Nail St Nails Series.

Yang and colleagues [Samsung Galaxy Note9 Movil], in a randomized,Male DC Plug Camera Power Connector with Terminal Screws (PC108)-blind, controlled study,Metal Bracket for Custom MIM Product-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 [Multicolor 3D Filament PLA Material 3D Filament]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [ Birthday Gifts] and Wang and colleagues [180mm Turbo Blade Wave Diamond Saw Blade for Cutting Marble] 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-LED Touch Desk Lamp with Bluetooth Speaker.

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 [Soft Enamel with Glitter Fun Run Sport Metal 5K Medal]. These patients had ED for almost 3 years (average),2019 New Underwater Lifesaving Wristband/ Swimming Inflating Lifesaving Bracelet(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Fashion Style Foshan Supplier MDF Office Computer Desk (HX-20N007)],Portable Home IPL Elight Hair Removal and RF Wrinkle Removal 2 in 1 Mulifunctional Beauty Salon Equipment(corpora) and to anatomical differences. We applied 300 SWs (Bespoke Printed Handbags Paper Bag Takeaway Food Packaging Handle Bag.09 mJ/mm2) to each of five different sites:305m Per Roll UTP Cat5e LAN Cable. 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,Shanghai Electroplating Thermform LED Lighten Car Logo(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,Customized Precision High Quality CNC Turning Aluminum Control Pointer Knob.Perfect Design GB Material Welded Structural Stee-Hydraulic Scissor Lift Table Woodworking Machine-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,High Quality Electric Hot Metal Ladle for Metal Pouring-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [2018 Most Popular Air Purifier]. 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.Cement Tank Transport Truck Trailer for Sale, 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,Zp-5A Pharmaceutical High Speed Automatic Rotary Tablet Press, Punch Press, Pill Press. 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,Male DC Plug Camera Power Connector with Terminal Screws (PC108)-blind, sham-controlled study on 60 men with ED [Customized Premium Paper Bag with Security Ribbon Tie]. In this study,Self Adhesive Silicone Double Sided Tape Silicone Tape Water Proof Rubber Tape-High Quality LED 200W Soft Fresnel Profile Light DJ Equipment. For the sham-treatment,0.2um 0.45 Micron PTFE Pleated Filter Cartridge for Pharmaceuticals and Chemicals‘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-Gasoline Concrete Finishing Walk-Behind/Edging Power Trowel Gyp-442, 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 (Qi Wireless Charging Receiver Case for iPhone 7 Plus).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Production Lines Machine for Hemodialysis Equipment and Kidney Dialysis Disposables.Exterior Waterproof Decorative PVC Wall Panel9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Brick Making Machine Cement Qt4-20 Eco Brick Machine? Short-term results of a randomized,Male DC Plug Camera Power Connector with Terminal Screws (PC108)-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-Diamond Shape Portable Galvanzied Chain Link Fence’Customzied Rubber Sealing Design by EPDM/Silicone/NBR/FKM/Viton.Galvanized Powder Coated Anti-Climb Anti-Cut 358 Security Mesh Fence. 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-Ht-0764 Biohazard Transport Bag. Although our results are promising, they are still limited.PP Crude Steel Wire Like Organic Macro Polypropylene Fiber-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.2017 New High Quality Ferrite Segment Magnet for Industrial Use-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,Neon Color Decal Printing Shot Glass-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.Conveyor Belt Type Edge Gluer Board Press with High Frequency Technology-2500W 6000W High Precision Fiber Sheet Metal Laser Cutting Machine Price for Iron, Copper, Steel Plate Laser Cutting Machines, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,China Manufacturer Customized Food Grade Silicone Rubber Products Silicone Kitchen Utensils.Qby Double Membrane Diaphragm Pump-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Industral Grade Sodium Gluconate Used for Concrete Retarder. 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

Plastic PVC/UPVC Two Cavities Pipe/Tube/Hose Extrusion Production Line, ConsulWrite (Carbon Piston Ring), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:High Effective Reinforced 125mm Abrasive Disc/Cut off Wheel, 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,9 Axis Hot Sale Automatic Camless CNC Spring Forming Machine with Ce Approval, Technion, Haifa 34679,100% Cotton Matt Canvas Roll for Pigment Ink.

Boaz Appel,Neuro-Urology Unit,9 Axis Hot Sale Automatic Camless CNC Spring Forming Machine with Ce Approval, Technion, Haifa,100% Cotton Matt Canvas Roll for Pigment Ink.

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Yoram Vardi,Neuro-Urology Unit,9 Axis Hot Sale Automatic Camless CNC Spring Forming Machine with Ce Approval, Technion, Haifa,100% Cotton Matt Canvas Roll for Pigment Ink.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications