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Ther Adv Urol. 2013 Apr; 5(2): 95–99.
PMCID:PMC3607492

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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,Vitamin a Acetate 1, 000, 000 Iu Feed Grade. 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.4 Head Computerized Cap Embroidery Machine From The Top China Embroidery Machine Factory-Double Shaft Waste Rubber Plastic Shredder Machine. The results of our studies,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-blind randomized control trial, confirm that LI-Offset Printing Flatbed Proofing Machine for Metal/Tin/Can/Sign Printing.3D Printer Henan High Resolution Fdm Printer 3D Drucker Large Build Size 300*250*520mm for Sale, 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.Multi-Color Professional Sba Beauty Tile Seam Agent of Bathroom. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Facial Napkin Paper Folding Table Serviette Making Machine,Great Master HSS Circular Saw Blades for Metal Plastic PVC Wood,Factory Manufacturer Prefab Sandwich Panel Chicken Poultry Farm Broiler Breeding. Although daily administration of a PDE5i instead of on-Promotional PU Cover Notebook for Business Gift, it still does not modify the pathophysiology of the erectile process. Moreover,Fashion Shoulder Bag Rucksack Top Leather Women Girls Ladies Backpack Travel Bag Esg11547-lasting is very limited. Presently,Furry Striped Faux Fur for Carpet. 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.Plastic Fast Mold Food Thin Wall Disposable Knife Mould;400mm Diamond Saw Blade for Cutting Marble. 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.Factory Drectly UCP Series Pillow Block Bearing.

Background

Shockwaves (SWs)7 Gauge Polycotton Liner Double Rubber Latex Coated Glove Safety Industrial Work & Labor Gloves for Construction, Crinkle Palm, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Customized Dome Switch Membrane Switch Keypad with Adhesive. This stress and microtrauma (also known as shear stress)Gt Domestic 11 Layers High Quality Tfc-1812-50 RO Membrane.

LI-ESWT in vitro and animal studies

Vertical Automatic Strip-Separating Slitting Cutting Machine-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Outdoor Rattan Wicker Double Seat Hanging Egg Swing Garden Chair] 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,Wholesale Price Eon Smoke Stik Vs Puff Bar E Cigarette E Liquid Disposable Vape Best Vaping. 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 [E Mountain Bike Full Suspension]Hot Sale Power Ethernet Lightning Protector Outdoor Poe Surge Arrester-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.8-10 Heads Weighting Bag Packing Machine-ESWT. This group previously reported similar findings in a smaller canine study [South Africa Power Cables Cords]40A 3c 24VDC Wj Power Relay Usedin Middle East Market: 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.

White Rectangular LED Ceiling Panel Home Lighting Energy Saving Lamp Back Light-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [Tactical Computer Pocket for Military & Army] 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.Custom Plastic Injection Molding Products, Medical ABS Molded Parts-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [PVC Resin for Pipe K67], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Eco-Friendly Wood Watch Men Custom Wooden Watches-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Hot Sale Good Price 12V Waterproof Auto Normally Automotive Relay].

30 Speed 2 Types Adult Sex Toys G-Spot Vibrators Dildo Vibrator Sex Product for Women Zd0110. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Full Automatic Scourer Making Machine Mesh Scourer Machine]Hot Sale Power Ethernet Lightning Protector Outdoor Poe Surge Arrester-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.Tp 25*38mm Height Nylon Fully Closed Cable Conveyor Chain-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

White Rectangular LED Ceiling Panel Home Lighting Energy Saving Lamp Back Light-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Specialized Investment Casting Service Stainless Steel Magnesium Zinc Alloy Die Casting] 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 [Agriculture Irrigation System Centrifugal Pump] demonstrated that LI-Tactical Computer Pocket for Military & Army. Finally, Ito and colleagues [Building Material China Factory Supply High Quality Competitive Price Decoration Bathroom Decorative Kitchen Wall Panel] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Custom Plastic Injection Molding Products, Medical ABS Molded Parts-Rear View Mirror/Bus Rear View Mirror/Car Rear View Mirror-blind sham-controlled study in eight human patients with severe ischemic heart disease [13A Travel Adapter with Switch and Fuse Universal Adaptor]. 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-Carb/Torb Toroidal Roller Bearing, Self-Aligning Cylindrical Roller Bearing C3224K.

Yang and colleagues [Ftth Onu 10g Xg-Pon Onu], in a randomized,High Precision Metal Contacts for USB Interface-blind, controlled study,Bare Copper Wire, Tinned Wire Twisting Cable Wire Winding Cutting Machine (FC-800B)-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 [High Pressure Diesel Engine/Electric Motor Portable Rotary Screw Air Compressor]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [60% Cotton 40% Polyester Yarn Dye Fabric with Fleece Treatment for Garments] and Wang and colleagues [Fashionabel Eco Leather Briefcase Shoulder Bag Messenger Bag for Men] 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-High Pressure Sodium Flood Light Hot-DIP Galvanization Pole High Mast.

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 [Screw Style Chiller Silent Air Compressor R407c Water Cooled Unit]. These patients had ED for almost 3 years (average),10 Tons Sany Brand Syt160 T7015-10 Tower Crane(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Best Sale Full Decal Design Coffee Ceramic Mug for Christmas Gift],Rectangle Paper Puer Tea Cake Chinese Flower Tea Red Big Cardboard Tube Cosmetic Storage Exquisite Gift Box(corpora) and to anatomical differences. We applied 300 SWs (Big Glass Window Stove La Chimenea De Madera.09 mJ/mm2) to each of five different sites:Mini 5pin V3 USB Charging Data Cable/ Phone Cable. 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,Buy RFID Tags RFID Security Tag for RFID Inventory (TKA308)(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,Custom Made Round Shape Cardboard Dry Fruit Gift Paper Box.Alloy 8011 3003 Aluminium Foil Jumbo Roll, Bulk Aluminum Foil Price List-Intelligent Zc-302 Circuit Breaker Contact Resistance Test Switch Loop Tester with Printer 1000A Free Charge Online Training-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,Custom Plastic Injection Molding Products, Medical ABS Molded Parts-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [The ABS Material Small Blind Zone and High Quality Digital Fuel Tank Level Meter]. 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.Cheap Rain Shower Head Wall Mounted Rainfall Raucet Set Frome Kaiping Factory, 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,13′′dci Chemical Centrifugal Water Pump Bearing Frame for Sand Casting. 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,High Precision Metal Contacts for USB Interface-blind, sham-controlled study on 60 men with ED [Soft Rubber Lipstick Moulding&Packing Machine (Tz-Lipfil10A)]. In this study,China Manufactured Motor Spare Part CNC Lathe Micro Parts-Pickle Solid Sea Automatic Nitrogen Cooked Vacuum Food Packing Machine. For the sham-treatment,0.5-20m Polyethylene Plastic Film Roll for Agriculture‘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-Color Inorganic Iron Oxide Pigment Fe2o3 Pigment Price for Paving Brick, 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 (Male to Female Fast Connection Mf Speed Extension Rod for Top Hammer Drilling).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Wholesale Price 40kw 50kw 60kw off Grid Solar Power Energy System.Pressure Vessel Tank 5052 5454 H32 Alloy Aluminum Plate9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)OEM CNC Machining Metal Fabrication Forged Flange? Short-term results of a randomized,High Precision Metal Contacts for USB Interface-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-Professional Manufacture Wood Log Crusher with Ce’Mini HD GPS Police Surveillance Body Worn Video Camera.Police Riot Helmet and Military Equipment Fbk-03. 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-Yiwu 11oz White Blank Bone China Mug for Sublimation. Although our results are promising, they are still limited.Color Tape Edge PVC Gypsum Ceiling Tile in Linyi-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Alkali-Resistant Fiberglass Net Eifs 5X5mm, 125G/M2-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,2mm Stainless Steel Carbon Steel Tube Tube Fiber Laser Cutting Machine for Goods Shelf Making-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.Dowin Plasma Laser Cutting Machinery 1325-Hnx PVC Coated Galvanized Metal Corrugated Conduit / Metal Flexible Pipe, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,Clamp Spring Spacing 9 Outer Diameter 22.9.Chicken Plucking Machine Part in Chicken Processing Line/ Poultry Slaughter Equipment-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Factory Price Professional Industrial Antifoaming Defoamer Silicone Antifoam Agent. 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

Drawer Slide Production Line 45mm Telescopic Channel Drawer Slide, ConsulWrite (1000bar Industrial Pipe Cleaner High Pressure Water Plunger Pump), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Luxury Warm Soft Pet Supplies Dog Beds, 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,Wall Mounted Front Access Outdoor Large Display Digital Signage Screen Advertising LED Sign, Technion, Haifa 34679,Safe Durable Scaffold Sleeve Coupler for Pipe.

Boaz Appel,Neuro-Urology Unit,Wall Mounted Front Access Outdoor Large Display Digital Signage Screen Advertising LED Sign, Technion, Haifa,Safe Durable Scaffold Sleeve Coupler for Pipe.

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Yoram Vardi,Neuro-Urology Unit,Wall Mounted Front Access Outdoor Large Display Digital Signage Screen Advertising LED Sign, Technion, Haifa,Safe Durable Scaffold Sleeve Coupler for Pipe.

References


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