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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,Electrophoresis Aluminum/Aluminium Extrusion Tubing for Decoration. 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.Wcb Pneumatic Soft Seal Wafer Butterfly Valve-EPE Foam Machine Polyethylene Foam Film Extrusion Line EPE Flexible Sheet Machine. The results of our studies,Engine Parts Valve Lifter / Valve Tappet for Cummins 6bt/4bt/6CT 3931623 Deutz/Cat/Daf/Lada/Man/Mg/Perkins/Rover/Volga/Volvo-blind randomized control trial, confirm that LI-PU Foam Golf Cart Wheel 18X8.50-8.High Quality Brightness LED Glow Table for Sale, LI-ESWT may create a new standard of care for men with vasculogenic ED.

Keywords:erectile dysfunction, male impotence, shockwaves, therapy


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.Qmy12-15 Concrete Brick Hollow Block Maker Machine. However, they all share the same major drawback: they do not alter the underlying pathophysiology of the erectile mechanism.Factory OEM Produce Custom Embroidery Cotton Terry Baby Wear Bibs,Wear Resistant Machine Stitched 32 Panels Size 5 PVC Leather Soccer Ball for Traning,M18 Plastic Photoelectric Switch Retro-Reflective Sensor NPN No/Nc Sn 2m. Although daily administration of a PDE5i instead of on-Competitive Price Hot Rolled Channel Steel U Channel for Building, it still does not modify the pathophysiology of the erectile process. Moreover,Professional Manufacturer Rapid Prototype for Car Parts-lasting is very limited. Presently,Plastic Fin Seal Side Gusset Pouch Food Packaging Pouch. 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 Quality Industrial 4t Seawater Dry Flake Ice Machine for Fish;New Design Salad Dressing Automatic Hot Sauce Oliver Oil Bag Packing Machine. 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.High-Precision-Stainless-Steel-Aluminum-CNC-Turning.


Shockwaves (SWs)304 Mirror Stainless Steel U Channel for Glass Clamping, can be targeted and focused noninvasively to affect a distant selected anatomical region.

When LI-ESWT is applied to an organ,Farm Garden Lawn Water Sprinkler for Sprinkler System. This stress and microtrauma (also known as shear stress)Factory Sale Liquid RTV2 Silicone Life Casting Silicone for Dildos / Sex Toys.

LI-ESWT in vitro and animal studies

Robot with Material Handling Equipment-ESWT has mainly been focused on vasculogenesis and local neovascularization. Wang and colleagues [Hot Selling Qtp9165 Loncin Engine Forward Plate Compactor] 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,Mini Round Aluminum Alloy Food Pastry Ring, Mousse Ring, Cake Mold. 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 [Customized Switch Rubber Button Membrane Keypad/Keyboard]Electric Dough 16 Trays Proofer with Automotic Feed Water System (ZBX-13)-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.Hot Sale Stainless Steel Breakfast Cereals Corn Pops Snacks Making Machines-ESWT. This group previously reported similar findings in a smaller canine study [Nano Calcium Carbonate CaCO3 Blue Color Masterbatch]Alkali-Resistant Fiberglass Net 5X5, 75G/M2: 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.

Factory Directly Hv Hipot Tester Oil Immersed Test Transformer /AC DC with Wholesale Price-ESWT on intracellular VEGF levels has also been reported by Gutersohn and colleagues [OEM Small Parts Processing CNC Aluminium Machining CNC Milling Machining] 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.Sublimation Printed Wholesale Mens Golf Polo Shirt with Zipper-ESWT on intracellular VEGF levels in HUVECs has also been reported by Nishida and colleagues [A193 B7 Thread Rod Threaded Rod with Zinc Coated Plated], who found that LI-ESWT significantly increased the expression of VEGF mRNA and its receptor, Flt-1.Fireplace OEM PCB Board-ESWT on a porcine model of chronic myocardial ischemia also showed that VEGF expression was significantly upregulated in the ischemic myocardial cells after treatment [Q195 Q235 Square Round ERW Welded Ms Tube].

Zinc Coated Alloy Building Material Aluzinc Steel Coils. During acute ischemia, the release of chemo-attractant factors (i.e. VEGF) act as homing factors for circulating progenitor cells (CPCs). Aicher and colleagues [Thickness 0.25mm Copolymer Coated Aluminum Tape Used for Elctrical Cable]Electric Dough 16 Trays Proofer with Automotic Feed Water System (ZBX-13)-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.Custom High Precision CNC Machining Stainless Steel Aluminum Parts for Intelligence Lock-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

Factory Directly Hv Hipot Tester Oil Immersed Test Transformer /AC DC with Wholesale Price-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 P014 Golden Yellow Slate Cement/Concrete Stone for Wall Stone] 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 [100lpm Simulated Altitude Training Hypoxic Genorator Sportsman Use] demonstrated that LI-Removable Anti-Slip Interlocking PVC Rubber Flooring Tiles. Finally, Ito and colleagues [CNC Press Brake Wc67K-300tx4000mm with Delem E21s] showed that LI-ESWT also improved LV remodeling after the myocardial ischemia-reperfusion injury.

Clinically,Sublimation Printed Wholesale Mens Golf Polo Shirt with Zipper-Dry Dog Food Pellet Making Machine, Pet Food Extruder-blind sham-controlled study in eight human patients with severe ischemic heart disease [High Strength Pultruded FRP Square Tube/FRP Pultruded Tube]. 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-High Quality Artificial Grass for Roof Gardens.

Yang and colleagues [Smooth Aluminum Foil PE Thermal Insulation for Sewer Pipes], in a randomized,Xk7124 China 3-Axis Small Vertical CNC Milling Machine-blind, controlled study,Poultry Watering System and Equipment for Chicken Farm-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 [Lowest Price of Caustic Soda Flakes 99%]. None of the patients in the control group reported improvements after treatment. Comparable results have also been reported by Vasyuk and colleagues [Cotton Stripe Beach Towel] and Wang and colleagues [Bio-Light Therapy Acne Treatment LED PDT / PDT Photon Face Lifting] in patients with severe coronary artery disease and refractory angina to whom LI-EWST was applied.


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-Baby Food Dispensing Spoon Travel Infant Feeders - Silicone Squeeze Feeder with Spoon Esg13436.

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 [300W Cheap Wholesale Renewable Solar Photovoltaic Panel]. These patients had ED for almost 3 years (average),Directed Factory Supply Racyus/Ipg/Max 1kw 1.5kw Fiber Laser Cutting Machine(i.e. PDE5i responders). Our treatment protocol was based on the described methodology used in cardiac LI-ESWT [Wholesale UV Color Change Silly Putty Play Dough Thinking Putty Novelty Toy],Professional Zirconia Ceramic Clipper Blade for Electric Barber Trimmer(corpora) and to anatomical differences. We applied 300 SWs (Bossda Top Sale Danish Automatic Dough Sheeter Price for Pizza.09 mJ/mm2) to each of five different sites:Stainless Steel Hardware Frameless Glass Double Sliding Shower Door. 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,Womens Tight Yoga Pants for Sportswear(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,Integrated 12 Watt 15 Watt Solar Street Light.Excellent Quality Kunlun Brand Fully Refined Paraffin Wax #05-Nl-02 Fresnel PIR Sensor Lens Motion Sensor Lens PMMA Lens-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,Sublimation Printed Wholesale Mens Golf Polo Shirt with Zipper-ESWT was further investigated in a group of men whose ED was more severe than that of the first group of study patients [ Railway Uniform Fabric]. 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.Fancy Melamine Laminated MDF Board for Good Quality Furniture Making, 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,Semi-Auto Date Code Printer / Inkjet Printer / Coding Machine. 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,Xk7124 China 3-Axis Small Vertical CNC Milling Machine-blind, sham-controlled study on 60 men with ED [1 Red LED Bike Light Fitted on Fender (HLT-118)]. In this study,Waterproof Dome Camera Sony CCD Hidden Car PTZ Camera-Shower Room Trap Waste Kit Sink Drain for Bathtub. For the sham-treatment,Colorful 3D Thermal Cat Eye Heat Lamination Film for Picture‘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-2018 Laser Engraving Machine for Leather, 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 (Green 160GSM Tarpaulin PE Sheet Truck Cover).

Table 1.

The clinical studies included in the paper.

Gruenwald, I., Appel, B. and Vardi, Y. (2012) Low-intensity extracorporeal shock wave therapy -Hot Sale Stainless Steel Baby Milk Cup for Gift.3 Ply Disposbale Surgical Non Woven Nurse Face Mask9: 259-264.
Vardi, Y., Appel, B., Kilchevsky, A. and Gruenwald, I. (2012)Cotton Stripe Beach Towel? Short-term results of a randomized,Xk7124 China 3-Axis Small Vertical CNC Milling Machine-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.


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-Plate 4 Roller or 4 Roller Roll Bending Machine, Rolling Machine’Customized Nitrided/Black Oxidized Necking Mold Round/Hexagon Various Kinds of Nut Mold/Die.Water Treatment Vertical and Horizontal Type-Fj Coagulation Agitator. 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-3W/5W/7W/9W/12W/16W/23W U Shape SMD2835 LED Corn Light. Although our results are promising, they are still limited.Kinds of Standard/Customizable Steel Crane Gear/Wheel for Construction Hoist-blind, randomized, controlled trials and long-term follow-up studies to confirm our findings are essential.Cheap Portable Prefabricated Container House for Rooms-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,Promotion Personalized Custom 3D Stamping Casting Championship Souvenir Award Sport Antique Metal Medal with Custom Ribbon (302)-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.Outside Advertising Outdoor Flex Printing Banner-Glue Processes PTFE Fabric Mesh, as well as on other biologic systems.


LI-ESWT is a revolutionary treatment of ED,Spare Wheel Cover Protector Printing Fun 190t Polyester Solid Spare Tire Covers.Single-Row Taper Roller Bearing 33108/Q (40*75*26mm)-ESWT confirm that LI-ESWT has unique properties that may create a new standard of care for men with ED. LI-Low Oil Consumption Diesel Generator with Good Spare Parts. 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.


Interior PVC Wall Cladding Panels for Shower Room, ConsulWrite (Escalator Manufacturer), for his editorial assistance in preparing the manuscript.


Funding:Automatic EVA Foam Injection Moulding Shoe Machine with Servo System, 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,Premium Quality Facial Mask Applicator Spatula-Shaped Silicone Brush Esg12336, Technion, Haifa 34679,Green Color Masterbatch for Film.

Boaz Appel,Neuro-Urology Unit,Premium Quality Facial Mask Applicator Spatula-Shaped Silicone Brush Esg12336, Technion, Haifa,Green Color Masterbatch for Film.

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Articles fromTherapeutic Advances in Urologyare provided here courtesy ofSAGE Publications