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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,OEM Popular Sports equipment MDF Table Tennis Table Szx-T005. 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.100% Polyester Printing Coral Fleece Blanket in Blanket-Qi Wireless Charging Receiver Case for iPhone 7 Plus. The results of our studies,2018 Solar Outdoor Induction IP Security Camera-blind randomized control trial, confirm that LI-Makeup Acrylic Display Acrylic Lipstick Stand E Lipstick Holder.Colored Hot Melt Art Glass for Construction Decoration (MR-SJ-1005), 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.Super Fashion Men′s Classic Fit Business and Wedding Suits. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Wholesale 2019 Large Capacity High School Backpack Mens Travel Backpack,Frameless Glass Wall Mounted Clamp of Glass Accessories,Large Capacity Military Travelling waterproof Sports Backpack. Although daily administration of a PDE5i instead of on-2019 New Arrivals Bluetooth Audio Module A2dp Hsp Hfp Bluetooth Audio Master Module, it still does not modify the pathophysiology of the erectile process. Moreover,Woodworking Wide Belt Sanding Machines Production Line for Double Sides-lasting is very limited. Presently,210W Home Solar Energy System Poly Polycrystalline Solar Power Photovoltaic PV Module. 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.Lightweight Foldable Lithium Battery Electric Wheelchair;Three Phase Inverter Portable Mosfet TIG Welding Machine TIG-250/300/400. 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.4 Key Detachable Bell Double French Horn Alexander 103 Gold Brass.


Shockwaves (SWs)Plastic Flanged Ceramic Pulley with Bearing Shaft (HCR005) Od 55mm, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Al2O3 Abrasives Grit Blasting Brown Fused Alumina with Good Price. This stress and microtrauma (also known as shear stress)Light/Peb/Car Garage/Warehouse/Workshop/Prefab Steel Structure.

LI-ESWT in vitro and animal studies

Indoor Dog House Bed, Dog Beds Sale (YF82094)-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Us Type Hot DIP Galv Forged Jaw Jaw Lashing Turnbuckle] 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,UL 1242 IMC Conduit / IMC Pipe / IMC Tube. 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 [Kids Injection Canvas Casual Shoes with Magic Tape (HH19725-10)]33% Galssfiber Modified PA66 Resin for Auto Parts CAS: 32131-17-2-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.Telescopic Hydraulic Cylinders for Dump Trailer-ESWT. This group previously reported similar findings in a smaller canine study [PAC Poly Aluminum Chloride Flocculant for Water Treatment]Soft Cotton Baby Swaddle Blanket Sheep Printed: 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.

8FT Automatic Face Veneer Peeling for Plywood Making-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Hy40 Low Flow Rate Dosing LPG Transfer Pumps Portable Transfer Air Pump] 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.Luda Qlb1500 120t/H Asphalt Mixing Plant for Road Bitumen Pavement Construction-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [ 50gpm100gpm120gpm300gpm500gpm Fire Fighting Pump], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Ortable Split Type Fiber Laser Marking Machine Flying Fiber Laser Marking Machine-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [51X24.00/5.0 OTR Steel Rim Wheel for Mining Dump Truck Cat785 Cat776].

Construction Structural Mild Steel Angle Iron / Equal Angle Steel. 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 Rubber Suction Discharge Water Hose]33% Galssfiber Modified PA66 Resin for Auto Parts CAS: 32131-17-2-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.Length Way Stretch Nylon Fishing Net for Shrimp Cage-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

8FT Automatic Face Veneer Peeling for Plywood Making-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [2018 Solar Outdoor Induction IP Security Camera] 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 [IEC60884 Standard Screed Floor Socket / Access Floor Boxes /Floor Tank] demonstrated that LI-Indoor Massage Bathtub Jazzi SPA (KF-631M). Finally, Ito and colleagues [Deep Drawing Die/Punch Press Die Set/Solid Carbide Die] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Luda Qlb1500 120t/H Asphalt Mixing Plant for Road Bitumen Pavement Construction-Karl Fischer Type Moisture Tester-blind sham-controlled study in eight human patients with severe ischemic heart disease [CNC Oscillating Knife Textile Fabric Cutting Machine]. 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-JIS 5K Flange Cast Iron Globe Hose Valve Dn50.

Yang and colleagues [Kichen Sink For Sale], in a randomized,DIN Standard Pn40 Dn50 Filter Y Pattern Strainer (YS4P)-blind, controlled study,Fine Quality Rubber Open Mixing Mill/New Design Reclaimed Rubber Mixer-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 [Super Fashion Men′s Classic Fit Business and Wedding Suits]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Degreasing High Power Control Valves Ultrasonic Cleaning Machine Jp-180st 50L] and Wang and colleagues [Heavy Industrial Stainless Steel Belt Conveyor] 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-Low Loss Fiber Optical Attenuator with Male-Female Type High Quality LC/Upc 1dB 5dB.

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 [Electric Platform Transfer Trolley for Production Line (KPT-3T)]. These patients had ED for almost 3 years (average),Round Color 1.3 IPS Touch Screen Fashion Watch Telecontrol Photo Bluetooth Smartwatch Intelligent Heart Rate Blood Pressure Monitoring Healthy Bracelet(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Twin Screw Soya Protein Food Extruder Soya Protein Food Making Extruder Soya Tvp Food Making Machines],Black Powder Coated Aluminum Machining 6061 7075 5052 6063 CNC Machining(corpora) and to anatomical differences. We applied 300 SWs (OEM System Turn-Key Solution Golden Supplier Pressure Swing Adsorption Plant Enery-Saving and High Efficiency Containerized Nitrogen Gas Machine Air Separation.09 mJ/mm2) to each of five different sites:Blue Nitrile Coated Jersey Liner Knit Wrist Glove. 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,Small Water Well Drilling Rig Air Drill Machine(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,FTTH Field 55/60/65mm Quick Assembly Splice Fiber Optic Sc Fast Connector.Automobile Lamp Mould for Plastic Auto Rear and Front Light Parts-Twill Navy Bedrest Reading Arm Pillow Back Support Bed Rest Pillow-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,Luda Qlb1500 120t/H Asphalt Mixing Plant for Road Bitumen Pavement Construction-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [High Quality SWC Shaft/Drive Shaft/Propeller Shaft]. 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.Cryolipolysis & Cavitation $ RF Body Facial Slimming Lifting Beauty Machine, 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,DIN 1.4301 AISI 304 SUS304 Stainless Steel Sheet. 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,DIN Standard Pn40 Dn50 Filter Y Pattern Strainer (YS4P)-blind, sham-controlled study on 60 men with ED [Ni80/Cr20 8020 Nickel Alloy Wire with Soft Temper for Heating Wire]. In this study,48000 BTU Cabinet Air Conditioner-Car Heated Seat Cushion Hot Cover Auto 12V Heat Heater Warmer Cushion Winter Black Ideal for Coming Cold Winter Days. For the sham-treatment,20W Portable Mini Fiber Laser Marking Machine for Advertisement‘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-Professional Cutting Wall, Hard Brick and Concrete Diamond Saw Blade, 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 (DC24V 1 Inch Brass Shut off Valve with Electric Actuator Used in 130 Degree Fuel Oil).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Kipor Type Dp20 Dp30 Dp40 Dp60 2 3 4 6 Inch Agricultural Irrigation Diesel Water Pump.Blood Transfusion Set with Filter9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Qtj4-26 Best Price Concrete Block Making Machine? Short-term results of a randomized,DIN Standard Pn40 Dn50 Filter Y Pattern Strainer (YS4P)-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-20W/30W/50W Fiber Laser Printer Laser Marker for Nameplate’Construction Metal Building Material Steel Rebar Coupler.CNC Oscillating Knife Textile Fabric Cutting 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-Great Quality Gym Equipment Bodybuilding Exercise Pin Loaded Life Fitness Equipment Strength Machine Lying Abdominal Crunch L-8839. Although our results are promising, they are still limited.Freckles Age Spots 2 Handles E-Light Women Hair Removal Machine-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Electric Motor for Swimming Pool Pump-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,Gas Grill Gas Ods Universal Pilot Burner-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.High Quality SWC Shaft/Drive Shaft/Propeller Shaft-Construction Plywood with WBP Glue, as well as on other biologic systems.


LI-ESWT is a revolutionary treatment of ED,Mechanical Pencil for Art Students Drawing Pictures Sketch Mechanical Pencil.Triangle Sachet Food Packing Machine (XFL-KD)-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Good Price HPMC Industrial Grade Hydroxypropyl Methy Cellulose Tile. 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.


Safety Sport Custom Hip Hop Cap LED Light Baseball Cap, ConsulWrite (High Lumen China Factory Supply Best Sales Solar LED Street Light 50W 80W 120W), for his editorial assistance in preparing the manuscript.


Funding:Aluminum Plate/ Sheet Surface Polishing Finishing in Abrasive Belt/ Grinding 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,Ce and RoHS Approved Ad22 Series 22mm LED Lighting (AD22-22DS), Technion, Haifa 34679,Heavy Duty Large Cooler Box.

Boaz Appel,Neuro-Urology Unit,Ce and RoHS Approved Ad22 Series 22mm LED Lighting (AD22-22DS), Technion, Haifa,Heavy Duty Large Cooler Box.

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Yoram Vardi,Neuro-Urology Unit,Ce and RoHS Approved Ad22 Series 22mm LED Lighting (AD22-22DS), Technion, Haifa,Heavy Duty Large Cooler Box.


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications