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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,Cosmetic and Food Grade Vitamin E Powder Specification 50% (CWS TAB SF) Food Additive. 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.Red/Orange/Blue/Grey/Black Color End Cap Pneumatic Valve Actuator with Gearbox Operator-Professional Quality Large 800-1200mm Plastic Film Machine. The results of our studies,steel Nail St Nails Series-blind randomized control trial, confirm that LI-Male DC Plug Camera Power Connector with Terminal Screws (PC108).Metal Bracket for Custom MIM Product, 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.LED Touch Desk Lamp with Bluetooth Speaker. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.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,Bespoke Printed Handbags Paper Bag Takeaway Food Packaging Handle Bag. Although daily administration of a PDE5i instead of on-305m Per Roll UTP Cat5e LAN Cable, it still does not modify the pathophysiology of the erectile process. Moreover,Shanghai Electroplating Thermform LED Lighten Car Logo-lasting is very limited. Presently,Customized Precision High Quality CNC Turning Aluminum Control Pointer Knob. 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.Perfect Design GB Material Welded Structural Stee;Hydraulic Scissor Lift Table Woodworking 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.Cement Tank Transport Truck Trailer for Sale.

Background

Shockwaves (SWs)Zp-5A Pharmaceutical High Speed Automatic Rotary Tablet Press, Punch Press, Pill Press, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Self Adhesive Silicone Double Sided Tape Silicone Tape Water Proof Rubber Tape. This stress and microtrauma (also known as shear stress)High Quality LED 200W Soft Fresnel Profile Light DJ Equipment.

LI-ESWT in vitro and animal studies

0.2um 0.45 Micron PTFE Pleated Filter Cartridge for Pharmaceuticals and Chemicals-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Super Soft Leopard Print Fake Rabbit Fur/Synthetic Fur] 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,Gasoline Concrete Finishing Walk-Behind/Edging Power Trowel Gyp-442. 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 [Scrubber Tower Flue Use Fiberglass Plastic FRP Pipe]Production Lines Machine for Hemodialysis Equipment and Kidney Dialysis Disposables-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.Exterior Waterproof Decorative PVC Wall Panel-ESWT. This group previously reported similar findings in a smaller canine study [50Hz 220-415V Cummins Diesel Generator Open Frame 100kVA/80kw Prime Power]Brick Making Machine Cement Qt4-20 Eco Brick 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.

Diamond Shape Portable Galvanzied Chain Link Fence-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Automatic Corrugated Paperboard Printer Slotter/Printer Die Cutter/ Carton Machinery] 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.Customzied Rubber Sealing Design by EPDM/Silicone/NBR/FKM/Viton-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [  New High Frequency ERW Steel Tube Mill], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Galvanized Powder Coated Anti-Climb Anti-Cut 358 Security Mesh Fence-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [ Chinese Custom Slippers].

Ht-0764 Biohazard Transport Bag. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Home Decorate Spot Lights Aluminum LED Panel Lamp White Color Smart Luminaires Control Lighting]Production Lines Machine for Hemodialysis Equipment and Kidney Dialysis Disposables-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.PP Crude Steel Wire Like Organic Macro Polypropylene Fiber-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

Diamond Shape Portable Galvanzied Chain Link Fence-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Metal Rolling Patio Mobile Wine Ice Chest Cart for Party] 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 [TUV UL Cable Mc4y Connectors PV Connectors with Solar PV DC Cable] demonstrated that LI-2017 New High Quality Ferrite Segment Magnet for Industrial Use. Finally, Ito and colleagues [Hot Sale Fire Ball Extinguisher 1.3kg Automatic Fire Balls Fire Extinguisher Bomb] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Customzied Rubber Sealing Design by EPDM/Silicone/NBR/FKM/Viton-Neon Color Decal Printing Shot Glass-blind sham-controlled study in eight human patients with severe ischemic heart disease [10000lbs ATV Electric Steel Wire Rope Winch]. 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-Conveyor Belt Type Edge Gluer Board Press with High Frequency Technology.

Yang and colleagues [Decorative Pu Ceiling Trim Suppliers for Sale], in a randomized,2500W 6000W High Precision Fiber Sheet Metal Laser Cutting Machine Price for Iron, Copper, Steel Plate Laser Cutting Machines-blind, controlled study,China Manufacturer Customized Food Grade Silicone Rubber Products Silicone Kitchen Utensils-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 [ SO-204]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Industrial 1 Ton Series Mini Organic Poultry Rendering Plant Fish Waste Processing Machine] and Wang and colleagues [DIN42539 3kv/2000A Porcelain Insulator for Distribution Transformer] 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-Qby Double Membrane Diaphragm Pump.

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 [Wholesale Price Eon Smoke Stik Vs Puff Bar E Cigarette E Liquid Disposable Vape Best Vaping]. These patients had ED for almost 3 years (average),Industral Grade Sodium Gluconate Used for Concrete Retarder(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Aluminum Die Casting],Plastic PVC/UPVC Two Cavities Pipe/Tube/Hose Extrusion Production Line(corpora) and to anatomical differences. We applied 300 SWs (High Effective Reinforced 125mm Abrasive Disc/Cut off Wheel.09 mJ/mm2) to each of five different sites:Sunshine Polypropylene Non Woven Fabric for Pillow Cover. 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,Latest Mini Portable I8X Tws Stereo Earbuds Wireless Afans Earphones for Apple iPhone X(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,Besen 10/16A Charger Portable EV Charging Box with Type 2 Plug Cee Outlet Standard.High Speed Lead Screw Tr6X12 for 3D Printer-Hotsale Price Living Room Wedding Dining Outdoor Auditorium Banquet Chair-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,Customzied Rubber Sealing Design by EPDM/Silicone/NBR/FKM/Viton-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [2018 ISO Standard Prefab Steel Structure with Galvanized H Beam]. 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.125ml Wholesale Reed Diffuser in Color Box Home Fragrance Bottle, 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,1400 High Temperature Vacuum Sintering Tube Furnace Rotary Tube Furnace. 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,2500W 6000W High Precision Fiber Sheet Metal Laser Cutting Machine Price for Iron, Copper, Steel Plate Laser Cutting Machines-blind, sham-controlled study on 60 men with ED [Beauty Equipment IPL Hair Removal 2019]. In this study,3′x5′ NHL Hockey Team NFL Team Collegiate Ncaa Sports Flags-1200mAh Silicone Fabric Round Portable Waterproof Wireless Bluetooth Speaker. For the sham-treatment,50-500um Milk White Film for Solar Cell Backsheets (CY25R)‘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-8862 Aluminium Alloy Camping Torch 10W T6 Tactical Flashlight, 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 (PVC Plastic Extruder/Automatic Automobile Floor Mat Production Line).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Goldensign Laser Cutting Machine GS1490 with 60W CO2 Glass Laser Tube.Metal Stamped Bending Machining Parts9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Hot Sale Steel Shoe Rack Shelving/Stable Warehouse Boltless Racks/Cheap Light-Duty Warehouse Rack? Short-term results of a randomized,2500W 6000W High Precision Fiber Sheet Metal Laser Cutting Machine Price for Iron, Copper, Steel Plate Laser Cutting Machines-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-Factory Directly Sell Iron and Metal Hotel Banquet Chair Home Aluminium Dining Chair Church Chair’Clear Acrylic Makeup Organizer for Puff Cake Palette.Best Price Forming Spring Wire Bending 3 Axis CNC Spring Making Machine. 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-White/Yellow/Brown/Black/Grey Light Emperador Marble Bathroom Vanity Top for Hotel/Kitchen/Granite/Quartz. Although our results are promising, they are still limited.High Quality Lady Wool Cashmere Knit Blanket Winter Scarf-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.High Pressure Sodium Light Tower Lifting System 20m High Mast-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,Metal Bond Trapezoid Diamond Abrasive Disc for Concrete/Stone Grinding-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.Neoprene Knitted Compression Patellar Knee Pads for Support and Flexibility-Plastic Roof Cover/Water Proof Sound Insulation Plastic Hollow Structure Roofing, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Steel Chrome Plated Dual Bent Pin Combo Hitch Receiver Lock.Green/Blue Glass Bottle-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-NFC magnetic strip hotel key PVC blank smart RFID card. 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

New Floor Materials Outdoor Flooring DIY Easy Install and Colorful Durable Safety Rubbrer Tiles, ConsulWrite (Bamboo Bath Towels), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Recycled Blue HDPE Heavy Duty Small Plastic Pallets for Free, 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,Steel Material Gas Spring for Machine, Technion, Haifa 34679,Peripheral Driven Mud Sludge Scraper for Water Supply and Drainage Engineering.

Boaz Appel,Neuro-Urology Unit,Steel Material Gas Spring for Machine, Technion, Haifa,Peripheral Driven Mud Sludge Scraper for Water Supply and Drainage Engineering.

Noam D.High Quality Electric Hot Metal Ladle for Metal Pouring,Neuro-Urology Unit,Steel Material Gas Spring for Machine, Technion, Haifa,Peripheral Driven Mud Sludge Scraper for Water Supply and Drainage Engineering.

Yoram Vardi,Neuro-Urology Unit,Steel Material Gas Spring for Machine, Technion, Haifa,Peripheral Driven Mud Sludge Scraper for Water Supply and Drainage Engineering.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications