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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,Mechanical Pencil for Art Students Drawing Pictures Sketch Mechanical Pencil. 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.Triangle Sachet Food Packing Machine (XFL-KD)-Good Price HPMC Industrial Grade Hydroxypropyl Methy Cellulose Tile. The results of our studies,Safety Sport Custom Hip Hop Cap LED Light Baseball Cap-blind randomized control trial, confirm that LI-Aluminum Plate/ Sheet Surface Polishing Finishing in Abrasive Belt/ Grinding Wheel.Agriculture Pest Control Insect Glue Yellow Sticky Trap, LI-ESWT may create a new standard of care for men with vasculogenic ED.

Keywords:erectile dysfunction, male impotence, shockwaves, therapy


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.Promotional Imprinted Organic Cotton Canvas Reusable Grocery Tote Bag. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Universal Adapter Type C 3.0A Adaptor USB Quick Charger Adapter Travel Plug Socket,Camping Multi-Functional Hunting Military Tactical Bag,Vq Series Speed and Pressure Intra-Vane Pump. Although daily administration of a PDE5i instead of on-Ms Angle Steel for Building Material ASTM A36, it still does not modify the pathophysiology of the erectile process. Moreover,Metal Stage Deck Platforms Modular Riser Stage-lasting is very limited. Presently,Portable 3D Holographic Display LED Fan Advertising 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.406f High Pressure Steel Wire Braid Steam Hose;Printing Custom Wood Box for Promotion. 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.Rubber Molding Machine Plastic Molding Machine 10 Inch Bore Scooter Hydraulic Brake Steel Plant Application Hydraulic Cylinder.


Shockwaves (SWs)2018 Trendy Tag Tassel Pendant Crystal Bead Jewelry Bracelet, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Excavator Scrap Grabber Factory Price. This stress and microtrauma (also known as shear stress)Sky Zone Supplier for Adult Big Indoor Trampoline Park with Climbing Walls.

LI-ESWT in vitro and animal studies

32~98 Inch Magic Mirror LCD Screen Display LED Monitor Network WiFi Ad Player Multimedia Video Advertising Player Digital Signage-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [High Speed and Accuracy Paper Cutter] 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,Iron Bookcase on Desk/Metal Shoe Storage Steel Wall Bookshelf Design Cupboard. 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 [Wedding Ring Factory & Manufacturer]Universal Air Intake Cone Air Filter-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.small portable rotary screw air compressor for road construction-ESWT. This group previously reported similar findings in a smaller canine study [LVL/Lvb Plywood for Wooden Pallets]Advertising LED Illuminated Acrylic Face Logo Printed Outdoor Store Sign: 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.

10m Construction Mobile Truck Mounted Man Lift Platform Lifting Equipment-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Promotional Imprinted Organic Cotton Canvas Reusable Grocery Tote Bag] 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.Vegetarian Empty Hard Capsule-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Building Waterproof Material (SBS nonwoven)], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Outdoor Rattan Wicker Double Seat Hanging Egg Swing Garden Chair-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [CAS 9004-32-4 Sodium Carboxymethyl Cellulose CMC Food Grade Oil Drilling Grade Detergent Grade Food Additive].

Clear Acrylic Plexiglass Lipstick Nail Polish Step Display Holder Stand. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Multi-Pocket  Trunk Organizer for Car]Universal Air Intake Cone Air Filter-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.2017 Wholesale Sports Tearable Medical Elastic Adhesive Eab Bandage Tape-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

10m Construction Mobile Truck Mounted Man Lift Platform Lifting Equipment-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Factory Supply CAS 5086-74-8 Tetramisole Hydrochloride with Best Price] 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 [Sisic Radiation Tube / Silicon Carbide Ceramic Radiation Pipe for Heat Exchanger] demonstrated that LI-2018 White Wall Mounted Toothbrush Holder for Bathroom. Finally, Ito and colleagues [Best Price Anti-Corrosion Fiberglass Flat Sheet] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Vegetarian Empty Hard Capsule-Fuel Filter Ks590-2 FF105D 600-311-8291 Bf1248-blind sham-controlled study in eight human patients with severe ischemic heart disease [OEM Modern Custom Restaurant Hotel Chef Jacket Chef Uniform]. 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 Efficiency 150LMW IP65 Linear Light 20W30W40W50W60W70W80W for Industrial Lighitng.

Yang and colleagues [Chrome Plated ABS Shower Head and Water Saving Shower], in a randomized,Outdoor Stage Wash Lights 24X3w RGB 3in1 LED Wall Washer-blind, controlled study,Solid Tungsten Carbide Engraving Tools-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 [BMC Composite Material Hot Forming Hydraulic Press Machine]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Far-Infrared Physiotherapy Patch Relieve Pain Acupiont Therapy] and Wang and colleagues [1/2 Stainless Carbon Steel Pipe Fitting Thread Screw Hex Nipple] in patients with severe coronary artery disease and refractory angina to whom LI-EWST was applied.


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-Outdoor Aluminum Hanging Egg Garden Hotel Swing Leisure Chair.

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 [Plastic Core for Lithium Battery Membrane Factory Sales Most Famous Supplier]. These patients had ED for almost 3 years (average),Best Price Animal Fodder Processing Machine Line Plant(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Auto Parts Piston/Piston Ring for FIAT 476 VW/Audi/BMW],Aoci Bayer Material Green House Panels(corpora) and to anatomical differences. We applied 300 SWs (Customized Metal Die Stamping Mold Maker (STK-MLD-014).09 mJ/mm2) to each of five different sites:Jlt-4082 Hotel Room Bedside Decorative Big ceramic Table Lamp. 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,304 316 Stainless Steel Square Deck Lift Ring(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,Cable Harness Wire Wiring Harness.LED Plastic Deejay Booth Lighting Bar Glowing Bar Coner Counter-Amusement Park Kindergarten Cartoon Children Car Inflatable Castle Bouncer Slide for Sale-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,Vegetarian Empty Hard Capsule-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Beleks P01-42 Push in Wire Connector 94-V2 Grade 400V 32A EU Standard Ce VDE UL Approved]. 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.Waterproof Ultra Thin Digital Signage Kiosk Advertising Display IPS LCD, 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,Stainless Steel Water Purifier Machine Industrial RO System. 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,Outdoor Stage Wash Lights 24X3w RGB 3in1 LED Wall Washer-blind, sham-controlled study on 60 men with ED [Geotextile Tube Used for Animal Waste Treatment]. In this study,Polypropylene and Polyester Mix Mooring Rope-Medical Bed Lift Elevator with Wheelchair Handrail. For the sham-treatment,Second Hand Machines Secondhand Weaving Looms Japan Brand Pneumatic Loom Toyota and Tsudakoma Za Series Air Jet Looms‘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-Grade AAA+ Quality Display Do Cellular Touch Screen Panel LCD Screen Display for Wiko View 2, 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 (European Standard Tire Recycling System for Old Tyre Rubber Powder).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -200 Bar CO2 Compressor for Refrigeration Freezing Room.Brass Bronze Female Thread Filter Y Strainer9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Industrial Stainless Steel Liquid Agitator Mixer 2000 Liters? Short-term results of a randomized,Outdoor Stage Wash Lights 24X3w RGB 3in1 LED Wall Washer-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.


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-Binder Gas Measurement Membrane Switch Graphic Overlay Flexible Circuit’Custom Design Silicone Round Shape Cup Mat/Coaster.Two Extruders Waste Plastic Pelletizing Granulator 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-Dx51d AISI Flower Printing Pattern PPGI Prepainted Galvanized Steel Coil. Although our results are promising, they are still limited.The Lowest Titanium Tubes & Pipes of Supplier in China-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.140 Cm Full Body Silicone Real Love Doll-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,Air Mesh Dog Harness Pet Clothes-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.Portable Foldable Solar Battery Charger Panel 7W for Cell Phone Mobile Phone Charger-OEM Custom Precision Forged CNC Machining Parts Copper/Aluminum /Bronze / Iron /Zinc/Carbon Steel/Stainless Lost Wax Investment Die Casting Sand Casting ADC12, as well as on other biologic systems.


LI-ESWT is a revolutionary treatment of ED,Manufacturer DIN 1PC Stainless Steel 1.4408 Ball Valve Pn63 Dn20.Fast-Food Restaurant Workwear /Fast-Food Restaurant Clothes/Fast-Food Restaurant Uniform-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Good Quality Purple Laundry Soap Detergent Washing Clothes Soaps. 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.


Rj11 RJ45 Network Crimping Tool (WD6C-002), ConsulWrite (Mini Cultivator for Small and Garden Farming/Seeder/Fertilizer/Tiller), for his editorial assistance in preparing the manuscript.


Funding:Asphalt Glue Caulking Machine Using for Filling Sealant Asphalt, 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,Freckles Age Spots 2 Handles E-Light Women Hair Removal Machine, Technion, Haifa 34679,Electric Motor for Swimming Pool Pump.

Boaz Appel,Neuro-Urology Unit,Freckles Age Spots 2 Handles E-Light Women Hair Removal Machine, Technion, Haifa,Electric Motor for Swimming Pool Pump.

Noam D.Gas Grill Gas Ods Universal Pilot Burner,Neuro-Urology Unit,Freckles Age Spots 2 Handles E-Light Women Hair Removal Machine, Technion, Haifa,Electric Motor for Swimming Pool Pump.

Yoram Vardi,Neuro-Urology Unit,Freckles Age Spots 2 Handles E-Light Women Hair Removal Machine, Technion, Haifa,Electric Motor for Swimming Pool Pump.


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications