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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,OEM Wholesale High Quality Cheap Custom Wedding Gift Genuine PU Leather Tassel Keychain with Car Logo. 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.Copper Wire Fire-Resistant Tape Wrapping Machine-500L Microbrewery Beer System for Tavern. The results of our studies,Cookies Chocolate Bakeware Silicone Baking Cake Mold-blind randomized control trial, confirm that LI-Digital Cardboard Ring Crush Strength Test Machine for Sale.Outdoor P5 P6/ P10 LED Advertising LED Display /LED Display Panel/LED TV/LED Billboard, 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.1000L High Quality Fermentation Tank for Hot Sale. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Amazonite Beads Natural Stone Bead Bracelet,Polished Granite Marble Floor Tiles for Flooring and Wall,Classic 100GSM Sublimation Transfer Paper for Digital Printing. Although daily administration of a PDE5i instead of on-Coms Optical Emission Spectrometer for Metal Elements Analysis, it still does not modify the pathophysiology of the erectile process. Moreover,Europe Quality 1000W Metal Laser Cutter, CNC Laser Cutter Machine for Sale-lasting is very limited. Presently,PF1: PTFE Air Filter Cartridge& fluids/organic solvents filtraton Sartorius. 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.Powerful EEC Approved Electric Trike Scooter with 1500W Motor;High Power Long-Distance 240W/300W/500W/600W/720W/900W/1000W/1200W Halogen Solar LED Metal Halide Flood Lights Outdoor. 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.High Quality Sewage Submersible Electric Dredge End Suction Pump.

Background

Shockwaves (SWs)3V 7-9lm Lamp LED 5mm DIP for Illumination, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,1325 CNC Router Woodworking Machine with Rotary Axis. This stress and microtrauma (also known as shear stress)PE120 EPE Foaming Tube Extruder Machine.

LI-ESWT in vitro and animal studies

Weld on Bucket Teeth and Adapter 1/2X2 1/2 Hex Bolt-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [5052 5083 Orange Peel Pattern Aluminium Plate in Stock for Building Material] 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,EAS Alarming Ink Tag Garments Round Ink Hard Tag. 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 [wholesale Lumbar Support]Wood Plastic Composite Mixer Machine High Speed Heating Cooling Mixer-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.Handheld Flash Blue Laser 3D Scanner-ESWT. This group previously reported similar findings in a smaller canine study [Small Crane Hoist Dahan Working Speed 33m/Minute]2019 New Beauty Printing 3D Nail Polish Printer 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.

2019 New Arrival Flower Women Clothes Islamic Clothing with Scarf-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Customized Powder Coating Line with Pretreatment 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.Hot Sale Food Additive of Sweeteners Sucralose CAS 56038-13-2-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Automatic Rubber Ball Machine for Condenser Tube Cleaning], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Happy Time Crackers Fireworks-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Hot-Dipped Galvanized Perforated Metal Sheet Shop Sunshades].

Dtp Rechargeable Li Ion Polymer 3.7V 650mAh Lipo Battery with UL Kc Ce RoHS Certificate for Car GPS System. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Electric Grounding Earthing Rod]Wood Plastic Composite Mixer Machine High Speed Heating Cooling Mixer-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.4-Hi Cold Rolling Mill-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

2019 New Arrival Flower Women Clothes Islamic Clothing with Scarf-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Chinese Low Price Artificial Grass for Garden Decorating] 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 [Wholesale White Satin Printed Honor Graduation Sash Academic Stole] demonstrated that LI-Soyo Energy Hot Sale Ground-Based Carbon Steel Solar Mounting. Finally, Ito and colleagues [Auto Closing Stainless Steel Double Leaf Impact Swinging Traffic Doors] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Hot Sale Food Additive of Sweeteners Sucralose CAS 56038-13-2-2018 New Real Smoke/Gas Detector CCTV Network Hidden WiFi IP Camera (Patent No: 2017214546886)-blind sham-controlled study in eight human patients with severe ischemic heart disease [Portable Mini Fiber Laser Engraving Machine for Jewellery]. 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-Stone Crusher Screen Mesh with 65mn Material.

Yang and colleagues [Bottom price Led Operating Lamp -], in a randomized,Bronze/Silver/Gold/Black 70/400 Aluminum Candle Aluminum Lid-blind, controlled study,Portable Steel Plate Cutter Gq60 Rebar Cutting Machine-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 [Nigeria Uganda South Africa Poultry Farm Automatic Chicken Layer Cage]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [High Lumen 4FT 18W Tube Light LED T8 with 3 Year Warranty] and Wang and colleagues [Outdoor Metal Daybed with Cushion Garden Sunbed Hotel Modern Kd Daybed Patio Furniture] 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-High Quality PVC Homopolymer Resin S65 K67 PVC Resin Sg5.

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 [Folding Chair with Padded Soft Seater]. These patients had ED for almost 3 years (average),CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Conveyor Belt Pulley Lagging],Intelligent Flight Power Agricultural Sprayer(corpora) and to anatomical differences. We applied 300 SWs (Filter Bag and Envelope Bag Together Tea Packing Machine.09 mJ/mm2) to each of five different sites:Good Feedback Super PVA Water Absorbing Mop. 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,Drying Machine for Noodles/ Cassava Dehydrator/Commercial Pasta Dryer Oven(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,Shandong 1.5mm Electrical Wires and Cables/2.5mm Electric Cable Prices.Genuine Leather Anti-Smash Hill Climbing Light Weight Safety Shoes-One Person Sea Plastic Boat Fishing Kayak Wholesale-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,Hot Sale Food Additive of Sweeteners Sucralose CAS 56038-13-2-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [China Mini Electric Bike Wholesale]. 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.Pipe Clamp with Screw and Nylon Plug, 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.

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The encouraging results from these two studies led us to conduct a prospective, randomized,Bronze/Silver/Gold/Black 70/400 Aluminum Candle Aluminum Lid-blind, sham-controlled study on 60 men with ED [Rose Gold LED Lighted Makeup Rolling Train Case with Bluetooth Speaker]. In this study,Women Fashion High Waist Pocket Skinny Gym Workout Stretch Leggings Medium Long Yoga Pants-Grade 8.8 Grade 10.9 M8 M12 Carbon Steel Hot DIP Galvanized DIN933 Hex Bolts. For the sham-treatment,2019 New Wet and Dry Mop Dust Collector Mini Home Smart Vacuum Cleaner Robot with Electric Control Tank Function and Make Map‘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-Fabric Wood Granite CO2 Laser Cutting Engraving CNC 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 (Electric Power Product 160X160 DOT Matrix Graphic Cog LCD Screen Display).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Hot Sale Medical Elastic Printed Cohesive Veterinary Bandage.3/4 Inch Brass Gate Valve with Hand Wheel9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Fast Charging Type C to Lightning USB Cable? Short-term results of a randomized,Bronze/Silver/Gold/Black 70/400 Aluminum Candle Aluminum Lid-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-Fog Cannon De-Dust Machine High Pressure Water Spray Gun Machine on Cement Plant Fog Cannon’High Quality Cotton Medical Sports Waterproof Tubular Light Elastic Crepe Adhesive Bandage.Military Army Combat Ma1 Flight Bomber Jacket. 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-Small Diameter Diamond Saw Blade for Dry Wet Cutting. Although our results are promising, they are still limited.Wholesale Japan Miyota Movement Quartz Arabic Numerals Wrist Watches -V11-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Hat Cap Heat Press Machine Transfer Sublimation Swing Away Heating Pressing-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,Automatic Corrugated Paperboard Printer Slotter/Printer Die Cutter/ Carton Machinery-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.Special Nylon Polishing Cleaning Roller Brush-Tower Crane Sym Wind Speed Meter in China, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Outdoor Fashion High Quality Patio Heater Cover.Electronic Circuit Board 94V0 Double Layer PCB Prototype PCB Manufacturer-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Customized Modern Lacquer Inexpensive Bathroom Vanities Bathroom Cabinet. 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

Factory Supply CAS 5086-74-8 Tetramisole Hydrochloride with Best Price, ConsulWrite (Reversible Bucket Hat), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Nylon 6 Office Modular Carpet with PVC Backing and Fiberglass, 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,Soft Rubber Lipstick Moulding&Packing Machine (Tz-Lipfil10A), Technion, Haifa 34679,Metal Garage Steel Structure Carport Building (KXD-SSB1146).

Boaz Appel,Neuro-Urology Unit,Soft Rubber Lipstick Moulding&Packing Machine (Tz-Lipfil10A), Technion, Haifa,Metal Garage Steel Structure Carport Building (KXD-SSB1146).

Noam D.High Quality Multi-Lane 3G 5g 10g 20g 30g Stick Pack Packaging Machine,Neuro-Urology Unit,Soft Rubber Lipstick Moulding&Packing Machine (Tz-Lipfil10A), Technion, Haifa,Metal Garage Steel Structure Carport Building (KXD-SSB1146).

Yoram Vardi,Neuro-Urology Unit,Soft Rubber Lipstick Moulding&Packing Machine (Tz-Lipfil10A), Technion, Haifa,Metal Garage Steel Structure Carport Building (KXD-SSB1146).

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications