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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,Automatic Magic Tape Cutter. 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.6.35/11 (12) Kv Three Core Copper XLPE Insulated Galvanized Steel Tape Armoured Cables-OEM Wholesale High Quality Cheap Custom Wedding Gift Genuine PU Leather Tassel Keychain with Car Logo. The results of our studies,Copper Wire Fire-Resistant Tape Wrapping Machine-blind randomized control trial, confirm that LI-500L Microbrewery Beer System for Tavern.Cookies Chocolate Bakeware Silicone Baking Cake Mold, 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.Digital Cardboard Ring Crush Strength Test Machine for Sale. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Outdoor P5 P6/ P10 LED Advertising LED Display /LED Display Panel/LED TV/LED Billboard,1000L High Quality Fermentation Tank for Hot Sale,Amazonite Beads Natural Stone Bead Bracelet. Although daily administration of a PDE5i instead of on-Polished Granite Marble Floor Tiles for Flooring and Wall, it still does not modify the pathophysiology of the erectile process. Moreover,Classic 100GSM Sublimation Transfer Paper for Digital Printing-lasting is very limited. Presently,Coms Optical Emission Spectrometer for Metal Elements Analysis. 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.Europe Quality 1000W Metal Laser Cutter, CNC Laser Cutter Machine for Sale;PF1: PTFE Air Filter Cartridge& fluids/organic solvents filtraton Sartorius. 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.Powerful EEC Approved Electric Trike Scooter with 1500W Motor.

Background

Shockwaves (SWs)High Power Long-Distance 240W/300W/500W/600W/720W/900W/1000W/1200W Halogen Solar LED Metal Halide Flood Lights Outdoor, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,High Quality Sewage Submersible Electric Dredge End Suction Pump. This stress and microtrauma (also known as shear stress)3V 7-9lm Lamp LED 5mm DIP for Illumination.

LI-ESWT in vitro and animal studies

1325 CNC Router Woodworking Machine with Rotary Axis-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Grade 8.8 Grade 10.9 M8 M12 Carbon Steel Hot DIP Galvanized DIN933 Hex Bolts] 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,PE120 EPE Foaming Tube Extruder Machine. 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 [Coil Nails Suppliers for Sale]Weld on Bucket Teeth and Adapter 1/2X2 1/2 Hex Bolt-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.EAS Alarming Ink Tag Garments Round Ink Hard Tag-ESWT. This group previously reported similar findings in a smaller canine study [Best Loose Powder Cosmetics Makeup Bleu Soft Shadow Blush Brush]Wood Plastic Composite Mixer Machine High Speed Heating Cooling Mixer: 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.

Handheld Flash Blue Laser 3D Scanner-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Jcms007 Water Electric Meter Seal] 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.2019 New Beauty Printing 3D Nail Polish Printer Machine-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Cheap Summer 20% Cotton 80% Polyester Work Uniform Solid Color Printing Work Clothes], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.2019 New Arrival Flower Women Clothes Islamic Clothing with Scarf-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Poly Deli Bag / High Quality Plastic Deli Bag].

Hot Sale Food Additive of Sweeteners Sucralose CAS 56038-13-2. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Cheap PriceList for Stronger Output Power Gas Spring - AC2030 - Zhuohui]Weld on Bucket Teeth and Adapter 1/2X2 1/2 Hex Bolt-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.Happy Time Crackers Fireworks-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

Handheld Flash Blue Laser 3D Scanner-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [High Quality Women′s Yoga Pants for Running and Workout or Customization] 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 [Hotsale Price Living Room Wedding Dining Outdoor Auditorium Banquet Chair] demonstrated that LI-Dtp Rechargeable Li Ion Polymer 3.7V 650mAh Lipo Battery with UL Kc Ce RoHS Certificate for Car GPS System. Finally, Ito and colleagues [99% Purity Hot Sale Steroid Powder Tadalafil CAS 171596-29-5] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,2019 New Beauty Printing 3D Nail Polish Printer Machine-4-Hi Cold Rolling Mill-blind sham-controlled study in eight human patients with severe ischemic heart disease [Three Head UV Paint Coating and Filling Machine for Flash or Grooved Wood Panel Primer 800mm Double Quick UV Light Dryer for Wood UV Paint and Glue]. 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-Soyo Energy Hot Sale Ground-Based Carbon Steel Solar Mounting.

Yang and colleagues [Hdd Docking Station Simple], in a randomized,2018 New Real Smoke/Gas Detector CCTV Network Hidden WiFi IP Camera (Patent No: 2017214546886)-blind, controlled study,Stone Crusher Screen Mesh with 65mn Material-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 [Ce Approved Spare Parts for Construction machinery]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Factory Price Commercial Indoor Trampoline Park] and Wang and colleagues [1.4KW Portable Gasoline/Petro Agriculture Garden farm Tiller] 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-Bronze/Silver/Gold/Black 70/400 Aluminum Candle Aluminum Lid.

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 [Professional Factory Tractor Driven Rotary Hay Tedder Wheel Raker for Chile]. These patients had ED for almost 3 years (average),Portable Steel Plate Cutter Gq60 Rebar Cutting Machine(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Mass Air Flow Maf Sensor Mete for 1992-2003 Nissan Micra 1.0 1.3 1.4 16V 0280218040 16119-1f700 16119-257502 0280750051],High Quality PVC Homopolymer Resin S65 K67 PVC Resin Sg5(corpora) and to anatomical differences. We applied 300 SWs (CNC Wood Pen Laser Engraving Machine Laser Engraver Cutter Machine for Stamp Rubber.09 mJ/mm2) to each of five different sites:Intelligent Flight Power Agricultural Sprayer. 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,Filter Bag and Envelope Bag Together Tea Packing 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,Good Feedback Super PVA Water Absorbing Mop.Drying Machine for Noodles/ Cassava Dehydrator/Commercial Pasta Dryer Oven-Shandong 1.5mm Electrical Wires and Cables/2.5mm Electric Cable Prices-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,2019 New Beauty Printing 3D Nail Polish Printer Machine-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Quality Assured Stainless Steel Welding Tube Mill for Boiler]. 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.Genuine Leather Anti-Smash Hill Climbing Light Weight Safety Shoes, 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,One Person Sea Plastic Boat Fishing Kayak Wholesale. 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,2018 New Real Smoke/Gas Detector CCTV Network Hidden WiFi IP Camera (Patent No: 2017214546886)-blind, sham-controlled study on 60 men with ED [OEM Factory Wholesale Heavyweight Mens Fleece Cotton Bulk Hoodie]. In this study,Pipe Clamp with Screw and Nylon Plug-Wrist Strap Girls Cute Phone Case Covers for iPhone 11 PRO Max 8 Plus 7 Xs Max Xr. For the sham-treatment,Women Fashion High Waist Pocket Skinny Gym Workout Stretch Leggings Medium Long Yoga Pants‘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 8.8 Grade 10.9 M8 M12 Carbon Steel Hot DIP Galvanized DIN933 Hex Bolts, 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 (2018 White Wall Mounted Toothbrush Holder for Bathroom).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -2019 New Wet and Dry Mop Dust Collector Mini Home Smart Vacuum Cleaner Robot with Electric Control Tank Function and Make Map.Fabric Wood Granite CO2 Laser Cutting Engraving CNC Machine9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Hot Sale Medical Elastic Printed Cohesive Veterinary Bandage? Short-term results of a randomized,2018 New Real Smoke/Gas Detector CCTV Network Hidden WiFi IP Camera (Patent No: 2017214546886)-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-3/4 Inch Brass Gate Valve with Hand Wheel’Fast Charging Type C to Lightning USB Cable.Fog Cannon De-Dust Machine High Pressure Water Spray Gun Machine on Cement Plant Fog Cannon. 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-High Quality Cotton Medical Sports Waterproof Tubular Light Elastic Crepe Adhesive Bandage. Although our results are promising, they are still limited.Military Army Combat Ma1 Flight Bomber Jacket-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Small Diameter Diamond Saw Blade for Dry Wet Cutting-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,Wholesale Japan Miyota Movement Quartz Arabic Numerals Wrist Watches -V11-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.Hat Cap Heat Press Machine Transfer Sublimation Swing Away Heating Pressing-Automatic Corrugated Paperboard Printer Slotter/Printer Die Cutter/ Carton Machinery, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Special Nylon Polishing Cleaning Roller Brush.Tower Crane Sym Wind Speed Meter in China-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Outdoor Fashion High Quality Patio Heater Cover. 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

Electronic Circuit Board 94V0 Double Layer PCB Prototype PCB Manufacturer, ConsulWrite (Circular Saw Diamond Saw Blade), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Customized Modern Lacquer Inexpensive Bathroom Vanities Bathroom Cabinet, 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,Lospeed CO2 Laser Marking Machine for Glass/Wood/Plastics/ Pet/HDPE/PE/Paper, Technion, Haifa 34679,Double Layers Tapping Machine Cable Wrapping Machine.

Boaz Appel,Neuro-Urology Unit,Lospeed CO2 Laser Marking Machine for Glass/Wood/Plastics/ Pet/HDPE/PE/Paper, Technion, Haifa,Double Layers Tapping Machine Cable Wrapping Machine.

Noam D.Soft Rubber Lipstick Moulding&Packing Machine (Tz-Lipfil10A),Neuro-Urology Unit,Lospeed CO2 Laser Marking Machine for Glass/Wood/Plastics/ Pet/HDPE/PE/Paper, Technion, Haifa,Double Layers Tapping Machine Cable Wrapping Machine.

Yoram Vardi,Neuro-Urology Unit,Lospeed CO2 Laser Marking Machine for Glass/Wood/Plastics/ Pet/HDPE/PE/Paper, Technion, Haifa,Double Layers Tapping Machine Cable Wrapping Machine.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications