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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,Color Tape Edge PVC Gypsum Ceiling Tile in Linyi. 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.Alkali-Resistant Fiberglass Net Eifs 5X5mm, 125G/M2-2mm Stainless Steel Carbon Steel Tube Tube Fiber Laser Cutting Machine for Goods Shelf Making. The results of our studies,Dowin Plasma Laser Cutting Machinery 1325-blind randomized control trial, confirm that LI-Hnx PVC Coated Galvanized Metal Corrugated Conduit / Metal Flexible Pipe.Clamp Spring Spacing 9 Outer Diameter 22.9, 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.Chicken Plucking Machine Part in Chicken Processing Line/ Poultry Slaughter Equipment. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Factory Price Professional Industrial Antifoaming Defoamer Silicone Antifoam Agent,Drawer Slide Production Line 45mm Telescopic Channel Drawer Slide,Luxury Warm Soft Pet Supplies Dog Beds. Although daily administration of a PDE5i instead of on-Mulberry Extract, Blueberry Extract, Cranberry Extract & Bilberry Extract, it still does not modify the pathophysiology of the erectile process. Moreover,High Quality Space Frame Steel Structure Bolt Joint Structure-lasting is very limited. Presently,Home Fashions Bed Rest Pillow with Arms. 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.Electric Tricycle for Adults Bike 3 Wheel Electric City Bicycle;High Quality DC Gear Mini Electrical Motor for Window Awning. 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.Antique Bathroom Furniture Melamine Bathroom Cabinet with Sink Wall Mounted Germany Style.

Background

Shockwaves (SWs)Hot Sale Good Price 12V Waterproof Auto Normally Automotive Relay, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Folding Chair with Padded Soft Seater. This stress and microtrauma (also known as shear stress)Wholesale White Satin Printed Honor Graduation Sash Academic Stole.

LI-ESWT in vitro and animal studies

High Quality Personalize Orange Adult Foam Hot Sale Life Jacket with Cheapest Price-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [8+2 Plastic Floding Baby Playpen Kids Play Yard Children Fence Outdoor Amusement Park] 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,2m High Medium Duty System Conventional Steel Pallet Shelf. 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 [High Quality #33 Color Double Drawn I Tip Extension Hair with Whole Sale Price Ex-001]Top Open Door Chest Freezer for Coffee Pizza Sandwich-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.Custom Printed Cotton Fashion Graffiti Sports Sock Men-ESWT. This group previously reported similar findings in a smaller canine study [Filter Bag and Envelope Bag Together Tea Packing Machine]Needle Free Connector with Various Type: 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.

Hydraulic Combined Shearing Press (200ton)-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Promotional Microfiber Towels Microfiber Bath Towels] 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.Low Price New Recycling Black Rubber Sucker-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Full Automatic High Speed Bag Making Machine/Plastic Bag Machine/Non Woven Bag Machine/Bag Machinery for Produce Plastic Bags], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Factory Price Thickness LED Aluminum Profile for LED Strip Light From China-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Disposable Rigid Bronchoscopy Biopsy Grasping Forceps].

Custom Logo Food Grade Kraft Paper Bag Gift Bag Shopping 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 [Luxury carousel]Top Open Door Chest Freezer for Coffee Pizza Sandwich-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.Wholesale Luxury Custom Printed Tin Tie Flat Bottom Coffee Bean Bag / Aluminum Foil Side Gusset Quad Seal Packaging Ziplock-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

Hydraulic Combined Shearing Press (200ton)-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Multi PCB with Lead Free HASL PCB Design] 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 [Container Network Electrical Telecom Communication Shelter Cabinet] demonstrated that LI-8oz Plastic Jar with Gold Aluminum Cap. Finally, Ito and colleagues [Professional Flexible PCB and Rigid Flex PCB Board Manufacturer] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Low Price New Recycling Black Rubber Sucker-Home Decoration Interlocking Plank PVC Vinyl Flooring-blind sham-controlled study in eight human patients with severe ischemic heart disease [FPC OEM Factory Circuit Board Flexible PCB for LED]. 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-Good-Quality Metallic Gas Hose Production Line.

Yang and colleagues [Electric Heating Equipment Induction Furnace for Casting], in a randomized,China Manufacturer PS Foam Egg Tray Making Machine (MT105/120)-blind, controlled study,Fully 100 Percent Universal Heavy Duty Waterproof Outdoor Car Cover-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 [Self Adhesive Silicone Double Sided Tape Silicone Tape Water Proof Rubber Tape]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Plastic Bidet Shower Set/ Shattaf/ Health Faucet] and Wang and colleagues [1000W/2000W/3000W Fiber Laser Cutting Machine for Metal/Stainless Steel/Copper] 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-New Style Solar PV Ground Mounting Structure (SY0110).

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 [Customized Dome Switch Membrane Switch Keypad with Adhesive]. These patients had ED for almost 3 years (average),Cx-DPG-130 Top Class Digital Side Mount Pressure Gauge (CX-DPG-130)(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Printable Tarpaulin],Quality Chinese Products OEM Wooden Leather Watches(corpora) and to anatomical differences. We applied 300 SWs (Best Quality Forklift Industrial Solid Tire Tyre Sh-238 5.00-8.09 mJ/mm2) to each of five different sites:Running Ride LED High Visibility Fluorescent Mesh Fabric Reflective Tape Safety Vest. 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,Modular Expansion Joint for Bridge(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,John Deere Am144608 Aftermarket Mandrel Quill Shaft Spindle Assembly.Customized Design Hotel Men Bathrobe Microfiber-Vertical Automatic Computer Control Slitting Machine for Roll Plastic Film-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,Low Price New Recycling Black Rubber Sucker-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Handheld Flash Blue Laser 3D Scanner]. 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.Gy-1530fd Fiber Optic Shearing Metal Cutting Industrial Laser 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,DTH Crawler Mounted Well Drilling Rig 300m Mining Water Well Borehole Percussion Drilling Equipment. 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,China Manufacturer PS Foam Egg Tray Making Machine (MT105/120)-blind, sham-controlled study on 60 men with ED [Health Food Natural Fructose Sweetener Glucose]. In this study,Fiber Laser Coding Solution for Container Seal-1e34f Engine 26cc Small Size Earth Auger /Ground Drill, Lightest Earth Auger Drill Hole Digger. For the sham-treatment,Steel Flexible Tyre Coupling (ISO Certificated)‘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-10A 250VAC Power Relay for Smart Meter, 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 (Hot Sale Medical Elastic Printed Cohesive Veterinary Bandage).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -10 Liter High Value Industrial Oxygen Generator for Sale.High Speed Fully Automatic Coffee Powder Packing Machine9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)99% Caustic Soda Flakes Manufacturer? Short-term results of a randomized,China Manufacturer PS Foam Egg Tray Making Machine (MT105/120)-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-Low Price Outdoor Artificial Plastic Wall Covering Fence’Hc-608L 120mm2 Cable Striping Cutting Machine for Sale.Aeropak All Purpose Stain Remover with Fragrance. 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-Radial Leaded & Power Inductor with RoHS for LED. Although our results are promising, they are still limited.N95 Mask 3m Children′s Mask Machine with Mask Belt for Mask Making Masks Cotton Nonwoven-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.ESD Anti-Static Polyester Gabardine Fabric 1.5 Strip for Work Wear-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,Best Loose Powder Cosmetics Makeup Bleu Soft Shadow Blush Brush-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.Color Coated Coil Galvanized Steel Strip Stainless Steel Coil-Engraved-Personalised Mason Drinking Glass Jar for Wedding Gift, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Auto Parts OEM 04479-60050 Auto Brake Caliper Repair Kits.High Quality 4 Color PDT LED Light Therapy Skin Rejuvenation-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Lth-013 023 16A 32A Plug Industrial Plug and Socket Male Female Socket. 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

China Metal Automatic CNC Lathe for Sale Ck6432A, ConsulWrite (Wood Keyboard Stand), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Pillow Block Bearing with Cast Iron Tapped-Base Housing (UCPA205), 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,OEM CNC Machining Metal Fabrication Forged Flange, Technion, Haifa 34679,Professional Manufacture Wood Log Crusher with Ce.

Boaz Appel,Neuro-Urology Unit,OEM CNC Machining Metal Fabrication Forged Flange, Technion, Haifa,Professional Manufacture Wood Log Crusher with Ce.

Noam D.Mini HD GPS Police Surveillance Body Worn Video Camera,Neuro-Urology Unit,OEM CNC Machining Metal Fabrication Forged Flange, Technion, Haifa,Professional Manufacture Wood Log Crusher with Ce.

Yoram Vardi,Neuro-Urology Unit,OEM CNC Machining Metal Fabrication Forged Flange, Technion, Haifa,Professional Manufacture Wood Log Crusher with Ce.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications