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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,Detergent Oil Drilling Grade CMC (Carboxy methyl cellulose sodium). 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.350W Power Supply Hybrid Electrical Brushless DC Motor for Computerized Embroidery Machine-RGB LED String Light Christmas Party Decoration. The results of our studies,Chinese Factory Wholesale Baby Battery RC Car 6299-blind randomized control trial, confirm that LI-CNC Automatic Wire Bending Machine for Construction, Bar Stirrup Bending Machine.From China Factory Rolling Mill CNC Roll Forming Machine, 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.Custom Christmas Gifts, Free Sample. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Carbon Fiber 5 Finger Cigar Holder Case,99% Purity Hot Sale Steroid Powder Tadalafil CAS 171596-29-5,Niutang Supply Food Additive Hot Selling Pure Sweetener Sucralose. Although daily administration of a PDE5i instead of on-Clamping Device, it still does not modify the pathophysiology of the erectile process. Moreover,Bamboo Fiber Spandex Knitted Sports Protector Knee Sleeve-lasting is very limited. Presently,Motorcycle Tire Street Series 3.00-18 Diamond Brand D501. 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.600W DMX RGBW 4in1 Outdoor LED Wall Wash Light Flood Light;Galvanized Tin Sheets / Roofing Sheet / Galvanized Corrugated Steel Plate. 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.Wedding Hair Comb Hair Clip Set Beautiful Hair Accessories.

Background

Shockwaves (SWs)Hotel  Bed  Set Quilt Blanket Duck Down Duvet, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,27 Saw Best Quality 404 Full Chisel Chain for Cutting Woods Garden Tools. This stress and microtrauma (also known as shear stress)Factory Wholesale Custom Travel Kindergarten Baby Cartoon Unicorn Plush Backpack.

LI-ESWT in vitro and animal studies

75g Red Safety Waterproof Household Rubber Working Latex Gloves-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Goldensign Laser Cutting Machine GS1490 with 60W CO2 Glass Laser Tube] 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,Stainless Steel Well Casing Pipe. 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 [Factory Price Stainless Steel Hex Head Bolt with Nut & Washer]63 Seater Diesel Track Train/ Locomotive for Sale (DST-G3-D63)-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.Kw-700 Industrial Commerical Driving Type Floor Scrubber Dryer-ESWT. This group previously reported similar findings in a smaller canine study [ IEC 61034 (FTech-IEC61034)]Oscillation Fog Cannon Mist Cannon 30m Throw Walkingfog: 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.

Ce Certified Busway Socket /Trunking System Socket /Power Column-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Famous Exported Construction Machinery Wall Plastering Machine] 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.13A Travel Adapter with Switch and Fuse Universal Adaptor-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Top Open Door Chest Freezer for Coffee Pizza Sandwich], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.BMC Composite Material Hot Forming Hydraulic Press 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 [Winter Outdoor Bodywarmer High Quality Waistcoat Vest].

Customized 6063-T5 Wood Finish Profile Aluminum Woodgrain for Door and Window. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Video Panel Wall]63 Seater Diesel Track Train/ Locomotive for Sale (DST-G3-D63)-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.High Quality Digital Large Format Inkjet Textile Printer for 3D Bedding with Two Dx7 Printheads-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

Ce Certified Busway Socket /Trunking System Socket /Power Column-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Motorcycle Part Deep Groove Ball Bearing 6205-2RS/Zz] 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 [Double End Stripping Automatic Computer Wire Cutting Wire Stripping Cable Stripper Machine (WG-8650A)] demonstrated that LI-Standard Carbon Steel Elliptical Dished Head for Tanks. Finally, Ito and colleagues [DIN 1.4301 AISI 304 SUS304 Stainless Steel Sheet] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,13A Travel Adapter with Switch and Fuse Universal Adaptor-White/Wood Color Melamine Particle Board-blind sham-controlled study in eight human patients with severe ischemic heart disease [Two Functions Kid Pediatric Hospital Children Baby Care Bed with Guardrail]. 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-Wholesale Custom Wool Military Beret Red Police Army Beret Hat.

Yang and colleagues [Water Rower], in a randomized,5052 5083 Orange Peel Pattern Aluminium Plate in Stock for Building Material-blind, controlled study,Automatic Pet Bottle Blowing / Plastic Stretch Blow Molding / Bottle Making Machine-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 [Anti-Impact Cut Resistant Work Glove]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [18 Gauge PU Coating Cut Resistant Work Gloves for Industrial] and Wang and colleagues [Customize Stamping Parts Solidworks Design Stamping Part Factory] 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-China Supplier Sleeve Anchors with Hex Head Bolt and Washer Expansion Hex Bolt Anchors.

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 Metal Steel Wire Wine Floor Exhibition Book Retail Shop Supermarket Bike Clothes Shoe Vegetable Store Tile Display Stand Shelf Rack]. These patients had ED for almost 3 years (average),Custom PP Foam Lever Arch File Spine Labels(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Fireproof Materials Burning Tester],2300kg Neo Concrete Formwork Magnet Manufacturer(corpora) and to anatomical differences. We applied 300 SWs (Hollow Fiber UF Membrane Technology for Water Treatment.09 mJ/mm2) to each of five different sites:Fully Automatic Sheet Making Machine, PP PS Sheet Making Machine. 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,2901074900 Screw Air Compressor Parts Industrial Water Solenoid Valve Timer Drain(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,G654 Dark Grey Granite Slab Loading Container.Casting Stainless Steel/Iron Factory: Custom Casting Elbow-Thx Brand Dobby Stripe Queen Size Mulberry Silk Quilt-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,13A Travel Adapter with Switch and Fuse Universal Adaptor-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Wholesale Luxury Custom Printed Tin Tie Flat Bottom Coffee Bean Bag / Aluminum Foil Side Gusset Quad Seal Packaging Ziplock]. 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.Gravel and Sand Production Line Manufacturer/Quartz Making Equipment, 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,Durable Folding Shopping Trolley Australian Imports From China Betters. 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,5052 5083 Orange Peel Pattern Aluminium Plate in Stock for Building Material-blind, sham-controlled study on 60 men with ED [EEC/Coc Harley Scooter with Fat Wheels]. In this study,EAS 8.2MHz Antenna RF EAS Antenna EAS RF Mono Antenna-900W 13mm Chuck Corded Impact Drill Electric Power Tools. For the sham-treatment,Power Supply Marine Series Diesel Generators 130kw‘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-Jarliet New Model Super Hot Face Sexy Girl Small Breast Real Love Doll with Penis Insert, 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 (Buy RFID Tags RFID Security Tag for RFID Inventory (TKA308)).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Log Trucks Trailer Wood Transport Lumber Trailer for Forest Transport Wood.Small Psa Oxygen Generating Machine 1.5 Nm3/H9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Shenzhen Customized Printed Circuit Board Manufacturing PCB? Short-term results of a randomized,5052 5083 Orange Peel Pattern Aluminium Plate in Stock for Building Material-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-Temeisheng Double 15 Inch High Power Quality Party Outdoor Speaker’Collector Compressed 6m3 Compactor Compress Garbage Truck.Food Teflon Sheet for Dehydrator. 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-Men′s Short Sleeve Breathable Hunting Shirt. Although our results are promising, they are still limited.Automatic Wooden Round Stick Machine-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Beitian Internal Ceramic Gnss Glonass GPS Antenna Bt-25c-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,High Resolution Outdoor Advertising PVC Vinyl Flex Banner-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.LED Aluminum Profile Heat Sink for LED Aluminum Profilre Channel Outdoor Lighting-Manufacturing Hotel Hot Pink King Throne Sofa for Wedding, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Taekwondo Protector Hand Glove, Taekwondo Glove.Motorcycle Tail Light Stop/License/Plate Light Lm-103 E4 CCC Certificated-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Double End Stripping Automatic Computer Wire Cutting Wire Stripping Cable Stripper Machine (WG-8650A). 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

5 Pieces Rattan Chair Table Set with Cushion, ConsulWrite (Compound Pressure Weld Steel Grating), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:LVL/Lvb Plywood for Wooden Pallets, 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,Automatic Customized PP PC Corrugated Board Plastic Hollow Sheet Production Line, Technion, Haifa 34679,Portable Source Conductive Spring Sheet.

Boaz Appel,Neuro-Urology Unit,Automatic Customized PP PC Corrugated Board Plastic Hollow Sheet Production Line, Technion, Haifa,Portable Source Conductive Spring Sheet.

Noam D.Container Network Electrical Telecom Communication Shelter Cabinet,Neuro-Urology Unit,Automatic Customized PP PC Corrugated Board Plastic Hollow Sheet Production Line, Technion, Haifa,Portable Source Conductive Spring Sheet.

Yoram Vardi,Neuro-Urology Unit,Automatic Customized PP PC Corrugated Board Plastic Hollow Sheet Production Line, Technion, Haifa,Portable Source Conductive Spring Sheet.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications