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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,Best Quality Forklift Industrial Solid Tire Tyre Sh-238 5.00-8. 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.Running Ride LED High Visibility Fluorescent Mesh Fabric Reflective Tape Safety Vest-Modular Expansion Joint for Bridge. The results of our studies,John Deere Am144608 Aftermarket Mandrel Quill Shaft Spindle Assembly-blind randomized control trial, confirm that LI-Customized Design Hotel Men Bathrobe Microfiber.Vertical Automatic Computer Control Slitting Machine for Roll Plastic Film, 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.Gy-1530fd Fiber Optic Shearing Metal Cutting Industrial Laser Machine. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.DTH Crawler Mounted Well Drilling Rig 300m Mining Water Well Borehole Percussion Drilling Equipment,Fiber Laser Coding Solution for Container Seal,1e34f Engine 26cc Small Size Earth Auger /Ground Drill, Lightest Earth Auger Drill Hole Digger. Although daily administration of a PDE5i instead of on-Steel Flexible Tyre Coupling (ISO Certificated), it still does not modify the pathophysiology of the erectile process. Moreover,10A 250VAC Power Relay for Smart Meter-lasting is very limited. Presently,10 Liter High Value Industrial Oxygen Generator for Sale. 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.High Speed Fully Automatic Coffee Powder Packing Machine;99% Caustic Soda Flakes Manufacturer. 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.Low Price Outdoor Artificial Plastic Wall Covering Fence.

Background

Shockwaves (SWs)Hc-608L 120mm2 Cable Striping Cutting Machine for Sale, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Aeropak All Purpose Stain Remover with Fragrance. This stress and microtrauma (also known as shear stress)Radial Leaded & Power Inductor with RoHS for LED.

LI-ESWT in vitro and animal studies

N95 Mask 3m Children′s Mask Machine with Mask Belt for Mask Making Masks Cotton Nonwoven-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Hen House for 500 Chickens Egg Layer Cages Chicken Coop] 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,ESD Anti-Static Polyester Gabardine Fabric 1.5 Strip for Work Wear. 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 [U Steel Bar Pressing Machine]Best Loose Powder Cosmetics Makeup Bleu Soft Shadow Blush Brush-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.Color Coated Coil Galvanized Steel Strip Stainless Steel Coil-ESWT. This group previously reported similar findings in a smaller canine study [Drywall Framing Steel Stud and Tracks for England Client]Engraved-Personalised Mason Drinking Glass Jar for Wedding Gift: 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.

Auto Parts OEM 04479-60050 Auto Brake Caliper Repair Kits-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [55 Inch LCD Panel for LG Display for Video Wall [Ld550dun-Tha3]] 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.High Quality 4 Color PDT LED Light Therapy Skin Rejuvenation-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [Custom Christmas Gifts], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Lth-013 023 16A 32A Plug Industrial Plug and Socket Male Female Socket-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Auto Gas Engine Spark Plugs K20r-U 90919-01166 for Denso K20ru Parts].

China Metal Automatic CNC Lathe for Sale Ck6432A. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Ultrasound Slimming Massager]Best Loose Powder Cosmetics Makeup Bleu Soft Shadow Blush Brush-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.Pillow Block Bearing with Cast Iron Tapped-Base Housing (UCPA205)-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

Auto Parts OEM 04479-60050 Auto Brake Caliper Repair Kits-ESWT on the myocardium has also been intensively studied in recent years. In a porcine model of ischemia-induced myocardial dysfunction, Nishida and colleagues [Factory Supply Color Zinc Plated J Hook Bolts with Nuts] 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 [Diamond Shape Portable Galvanzied Chain Link Fence] demonstrated that LI-1.08 Inch TFT/LCD display/screen Module in resolution 128X220. Finally, Ito and colleagues [Cn565b Max Style Heavy Duty Professional Air Coil Nail Gun/Nailer] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,High Quality 4 Color PDT LED Light Therapy Skin Rejuvenation-Flappy The Elephant and Elephant Wubba Nub Pacifier Gift Set-blind sham-controlled study in eight human patients with severe ischemic heart disease [Portable 3D Holographic Display LED Fan Advertising Equipment]. 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-UHF EPC G2 RFID Self Adhesive Label.

Yang and colleagues [Clear Machine Stretch Film 20 X 6000′ X 80 Gauge], in a randomized,Daf Truck Spare Parts Daf Wheel Nut Bolt 1337020/620646/1309091-blind, controlled study,Universal Motor / Flour Mill Motor / Blender Motor / Food Processor Motor-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 [ Walnut Veneered MDF Board]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [2019 New Wet and Dry Mop Dust Collector Mini Home Smart Vacuum Cleaner Robot with Electric Control Tank Function and Make Map] and Wang and colleagues [High Precision Artificial Flower Making Machine] 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-Alumina Ceramic Lined Pipe Tube Fittings.

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 [Automatic PS Foam Food Box Making Machine]. These patients had ED for almost 3 years (average),Printable Grey PVC Flex Banner for Advertising Digital Printing(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Level 3 Cut Resistant Knitting Working Gloves],Gold Bathroom-Wall-Way-to-Install-Whole(corpora) and to anatomical differences. We applied 300 SWs (Kj130 Spiral Duct Machine Spiral Tube Forming Machine Corrugated Steel Pipe Making Machine.09 mJ/mm2) to each of five different sites:Waterproof Elevator Componenets Safety Parts. Electronic Lift. 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,Chlorhexidine Acetate Powder CAS No. 56-95-1 with High Purity(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,Specialized Investment Casting Service Stainless Steel Magnesium Zinc Alloy Die Casting.Customized Child Coloring Book Hotsale Kids Hardcover Creative Board Puzzle Book Printing-Oil Proof Anti-Slip Kitchen/Bathroom Rubber Sheet/Mat-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,High Quality 4 Color PDT LED Light Therapy Skin Rejuvenation-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [Best Selling Cheap Food Grade 304 Stainless Steel Whiskey Ice Cube with Logo Laser]. 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.180mm Turbo Blade Wave Diamond Saw Blade for Cutting Marble, 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,Black Embossed Leather Reflective Stripe Safety Work Shoes (SF-603). 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,Daf Truck Spare Parts Daf Wheel Nut Bolt 1337020/620646/1309091-blind, sham-controlled study on 60 men with ED [100% Cotton Matt Canvas Roll for Pigment Ink]. In this study,300GSM Nylon Single Jersey Fabric with Cotton Hand Feel-Hot-Sell Watermelon Crystal Gold-Plated Earring Pendant Necklace Set. For the sham-treatment,USB Hub & USB C Hub& USB-C to HDMI 4K and USB 3.0 + Pd Power Charging Multiport Adapter‘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-OEM Laser Level Meter PRO 01 for Construction Mini Type, 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 (EAS 8.2MHz Antenna RF EAS Antenna EAS RF Mono Antenna).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Stainless Steel Mass Flow Meter with 4-20mA Pulse Alarm Output.Doxycycline HCl USP/GMP Pharmaceutical Raw Materials9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Colored Steel Roof/Building Materials? Short-term results of a randomized,Daf Truck Spare Parts Daf Wheel Nut Bolt 1337020/620646/1309091-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-Gold Supplier Palm Harvester Oil Extraction Machinery/Vegetable Oil Machinery Prices’3200mm High Speed Fluting Corrugated Kraft Liner A4 Copy Printing Tissue Toilet Packing Paper Making Machine.High Quality FDA Approved Ha Dermal Filler Hyaluronate Gel for Lips Cross Linked Hyaluronic Acid. 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-Motorcycle Part Deep Groove Ball Bearing 6205-2RS/Zz. Although our results are promising, they are still limited.Hen House for 500 Chickens Egg Layer Cages Chicken Coop-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.CAS 9004-32-4 Sodium Carboxymethyl Cellulose CMC Food Grade Oil Drilling Grade Detergent Grade Food Additive-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,Fashion Hot Sale Womens Leisure Training Jogging Suit-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.51X24.00/5.0 OTR Steel Rim Wheel for Mining Dump Truck Cat785 Cat776-Telescoping Metal Pulsating Lawn Sprinkler on Tripod 2-4FT Adjustable Height, as well as on other biologic systems.

Conclusions

LI-ESWT is a revolutionary treatment of ED,1.5m display Fridge for Restaurant Use.China Factory Tungsten Carbide Double Head T Type Milling Cutter-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Y2 Series Electric Motor. 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 Mini Electric Bike Wholesale, ConsulWrite (Clear Laminate Roll), for his editorial assistance in preparing the manuscript.

Footnotes

Funding:Structure Steel Fabrication, Construction Building Materials, High Precision Welding Metal Parts, 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,China Manufacturer PS Foam Egg Tray Making Machine (MT105/120), Technion, Haifa 34679,Fully 100 Percent Universal Heavy Duty Waterproof Outdoor Car Cover.

Boaz Appel,Neuro-Urology Unit,China Manufacturer PS Foam Egg Tray Making Machine (MT105/120), Technion, Haifa,Fully 100 Percent Universal Heavy Duty Waterproof Outdoor Car Cover.

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Yoram Vardi,Neuro-Urology Unit,China Manufacturer PS Foam Egg Tray Making Machine (MT105/120), Technion, Haifa,Fully 100 Percent Universal Heavy Duty Waterproof Outdoor Car Cover.

References


Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications