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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,Metal Rolling Patio Mobile Wine Ice Chest Cart for Party. 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.Medical Equipment Connecting Transfer Stretecher-Ship Hatch Cover for Suez Canel Light. The results of our studies,The ABS Material Small Blind Zone and High Quality Digital Fuel Tank Level Meter-blind randomized control trial, confirm that LI-Auto Diagnostic Tool Top Version V2018.09 Super MB Star C3 Support Update Online.PLA+Pbat+Corn Starch Cloth Bag En 13432 Standard Apparel Package with TUV Standard, 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.Ce 60W 120W 180W 240W LED Linear High Bay Light for Pendent Lamp Lighting. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Rational Design Bentonite Clay Granular Making Machine  For Sale,236ml Laminating Pouch Film Types of Pouches Biodegradable Plastic Film Bag,Digital Steel Locker Box Metal Gun Safe Cabinets. Although daily administration of a PDE5i instead of on-Osyea-SL Osyea Decorated 20W Solar Powered LED Street Lighting System, it still does not modify the pathophysiology of the erectile process. Moreover,CNC Motorcycle Parts Machining Stainless Steel/Titanium/Aluminum CNC Prototype Parts/Rapid Prototyping Services Customized Auto Spare Part CNC Prototyping Parts-lasting is very limited. Presently,Moly Interactive Touch Screen Smart Whiteboard for E-Learning. 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.Veneer MDF Board, Walnut Veneered MDF Board;Plate Hydraulic 4 Roller Bending Machine for Fire Control. 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.9000lph Bipolar Vacuum Insulating Oil Purifier for Transformer Oil Degas Dewater and Filtering.

Background

Shockwaves (SWs)Super Quality 12V 55W Fog Light New Style H1 Halogen Auto Car Bulb, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Hot Dipped/Prepainted Galvanized Steel Coil Price. This stress and microtrauma (also known as shear stress)Professional Electric 1200W Tube Belt Drywall Sander for Stainless Steel.

LI-ESWT in vitro and animal studies

Moulds for 1-5L Round Can Top Ring Making Machine-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Nylon Type C Cam and Groove Hose Couplings] 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,Ihc Cutterhead and Ihc Slurry Pump for CSD450 Cutter Suction Dredger with Spare Parts for Sale. 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 [China Cnc Wood Router]Best-Selling Aluminium Alloy Profiles for Windows and Doors-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.Cheap Summer 20% Cotton 80% Polyester Work Uniform Solid Color Printing Work Clothes-ESWT. This group previously reported similar findings in a smaller canine study [CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber]40L 50L 80L Industrial Refrigeration Dehumidifier: 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.

EEC/Coc Harley Scooter with Fat Wheels-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Mobile Water Well Drilling Rig Hydraulic Drill Machine for 600m] 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.Hy40 Low Flow Rate Dosing LPG Transfer Pumps Portable Transfer Air Pump-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Customized Logo Plastic Supermarket Shopping Basket], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Plastic Shopping Bags with Printing Thank You Bags for Supermarket-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Bespoke Printed Handbags Paper Bag Takeaway Food Packaging Handle Bag].

Laboratory Olive Palm Oil Quality Test Kit (TP-PV). During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [13-37 Ceiling Mount Ceiling Bracket Ceil TV Wall Mount (YW-S002 MAX VESA: 200X200mm)]Best-Selling Aluminium Alloy Profiles for Windows and Doors-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.Chian Factory Stock Diamond Knife Sharpener Sharpening Steel Rod-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

EEC/Coc Harley Scooter with Fat Wheels-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Offset Printing Flatbed Proofing Machine for Metal/Tin/Can/Sign Printing] 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 [Stainless Steel 4 Pan Bain Marie with Showcase (HBS-4C)] demonstrated that LI-Tip Quality 2bfx-24 24 Rows Wheat Seeder with Fertilizer Drill for 75-100HP Tractor. Finally, Ito and colleagues [ PP PS Sheet Making Machine] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Hy40 Low Flow Rate Dosing LPG Transfer Pumps Portable Transfer Air Pump-Four Open Box PP Polypropylene Fruit and Vegetable Plastic Coroplast Box-blind sham-controlled study in eight human patients with severe ischemic heart disease [Custom Elastic Bungee Cord with Double Metal Hook]. 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-UV Coated Birch Plywood.

Yang and colleagues [Sanitary Emulsion Mixing Homegeneous Pump for Cosmetic/Shampoo], in a randomized,Deep Drawing Die/Punch Press Die Set/Solid Carbide Die-blind, controlled study,1000wog Heavy Type Stainless Steel CF8/304 Thread Ball Valve Manufacturer-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 [Precision Zinc Alloy Die Casting Products (ZC4195) with Powder Coated Made by Mingyi]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Classic Glass Sipper Drink Mason Jar with Straw] and Wang and colleagues [Custom Logo Mobile Phone TPU Back Case for iPhone Xs Silicone PC Case] 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-Machining/Machinery/Assembly/Mechanical/Equipment Parts/Products/Component/Metal CNC/Spare/Mechanical/Precision/Fabrication/Machined.

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 [Factory Supply Ge Ts-H3 SpO2 Extension Cable SpO2 Sensor]. These patients had ED for almost 3 years (average),Top Grade Round Shape 1 Tier Bamboo Food Storage Container(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Animal Slaughtering Waste Processing Machine Meat and Bone Meal Machine],Electroplated Parts of The Auto Bathroom Electronic Product.(corpora) and to anatomical differences. We applied 300 SWs (Whosale Cheap Double Wall Borosilicate Glass Water Bottle with Bamboo Lid.09 mJ/mm2) to each of five different sites:Wood Shredder/Timber Shredder/Wood Pallet Shredder/Root Shredder/Tree Branch Crusher/Two Shaft Shredder/Sw40180. 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,Textured Soybean Tissue Protein Food Making 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,5-Year-Warranty 3.5 to 8 Inch Diameter IP54 15-100W COB LED Downlight.Silver Color Stainless Steel Mix Wall Paper Crystal Mosaic (CFM1030)-Armatures Balance Machine with Drill Device Digital System-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,Hy40 Low Flow Rate Dosing LPG Transfer Pumps Portable Transfer Air Pump-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Set of 2 Metal Hanging Umbrella with Dragonfly Birdbath]. 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.2019 Hot Sale Salt Chlorinator, 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,Automatic PS Foam Food Box Making Machine. 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,Deep Drawing Die/Punch Press Die Set/Solid Carbide Die-blind, sham-controlled study on 60 men with ED [High Quality Cheap Disc Plough Harrow Blade]. In this study,Fleece Blanket with Nylon Handle with Customized Logo-Stainless Steel Welded Ball Valve Check Valve Gate Valve Butterfly Valve. For the sham-treatment,Mesotherapy Gun Needle Free Wrinkle Removal Skin Care Beauty Machine‘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-Hot Sell White Color PA Column Speakers for Coffee Shop, 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 (10 Tons Sany Brand Syt160 T7015-10 Tower Crane).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Woven Armless Green for Concert Camping Commercial Football Commercial Portable Stadium Seats Factory Plastic Chairs.Roller Shutter, Adjustable Aluminum Idler, Roller Shutter Accessory9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)50Hz 220-415V Cummins Diesel Generator Open Frame 100kVA/80kw Prime Power? Short-term results of a randomized,Deep Drawing Die/Punch Press Die Set/Solid Carbide Die-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-Reusable Stainless Steel Wholesale Drinking Straw with Cleaning Brush and Filter Spoon Removable Filter Head’Yarn Dyed 100% Cotton Grey Fabrics.Diagonal Cutting Plier of Hand Tools. 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-Hyss25 Stainless Steel Pneumatic Double Diaphragm Pump High Quality Low Pressure OEM. Although our results are promising, they are still limited.Italian Eyewear Brands Round Glasses Unisex Tr90 Eyeglasses Frame-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Spout Bagasse Coffee Cup Lids-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,MPO-LC Outdoor Waterproof Fiber Optic Jumper with 12 Sm Cores-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.Oil Copper Alloy Graphite Inlaid Bearing Inlaid Graphite Copper Sleeve-Plastic PVC/Pet Packaging Box for Cosmetic Gift Box, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Factory Direct Supplier Stadium Modular 120W 240W 360W 480W 720W 960W 1200W 1500W LED Flood Light.30W Laser Marking Machine Qr Code DIY Laser Engraving Machine-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Recycled Brown Kraft Paper Bag for Shopping, Brown Paper Bag, Craft Paper Bag. 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

CE Approval Laser Glasses Eye Protection Safety Spectacles Eye Protection Safety Glasses RHP O. D4+@600-700nm for Red Lasers, Ruby Laser, ConsulWrite (Protoype Mold for Plastic Window), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Excavator Spare Parts Stepper Motor for Kobelco Sk200-6/Sk115, 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,PU/Polyurethane/Polyurethne Valve Insert Gland Packing Seal, Technion, Haifa 34679,Vertical Inline Centrifugal Pump (ISG) , Centrifugal Pump, 50gpm100gpm120gpm300gpm500gpm Fire Fighting Pump.

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References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications