Sessions Of Extracorporeal Shock Wave Therapy Research Articles

Extracorporeal shock‐wave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration in a rat model of STZ‐induced diabetes

Extracorporeal shock-wave therapy (ESWT) has a significant positive effect in accelerating chronic wound healing. However, the bio-mechanisms operating during ESWT of wounds remain unclear. This study investigated the effectiveness of ESWT in the enhancement of diabetic wound healing. A dorsal skin defect (area, 6 x 5 cm) in a streptozotocin-induced diabetes rodent model was used. Fifty male Wistar rats were divided into five groups. Group I consisted of nondiabetic control; group II included diabetic control receiving no ESWT; group III included rats that underwent one session of ESWT (ESW-1) on day 3 (800 impulses at 0.09 mJ/mm(2)) postwounding; group IV included rats that underwent two sessions of ESWT (ESW-2) on days 3 and 7; and group V included rats that underwent three sessions of ESWT (ESW-3) on days 3, 7, and 10. The wound healing was assessed clinically. Blood perfusion scan was performed with laser Doppler. The VEGF, eNOS, and PCNA were analyzed with immunohistochemical stain. The results revealed that the wound size was significantly reduced in the ESWT-treated rats, especially in the ESW-2 and ESW-3 groups, as compared with the control (p<0.01). Blood perfusion was significantly increased after ESWT compared with the controls. Histological findings revealed a significant reduction in the topical pro-inflammatory reaction in the ESWT group as compared with the control. In immunohistochemical stain, significant increases in VEGF, eNOS, and PCNA expressions were observed in the ESWT group, especially in the ESW-2 and ESW-3 groups, as compared with the control. In conclusion, treatment with an optimal session of ESWT significantly enhanced diabetic wound healing associated with increased neo-angiogenesis and tissue regeneration, and topical anti-inflammatory response.

Preliminary findings from a new animal model for Peyronie’s disease involving extracorporeal shock waves

To develop an experimental model in rabbits to analyse the efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease. We used 15 adult male rabbits divided into three equal groups. In group 1 (no penile ESWT) rabbits had three sessions of ESWT with 2000 shocks each (15 kV), but a rubber mat was placed between the shock head and rabbit to protect the penis; the rabbits were killed at 7 days after the last session of ESWT. In group 2 the rabbits had three sessions of ESWT using the same parameters, and were killed immediately after the last session to analyse the penis. In group 3 the rabbits had three sessions of ESWT as before but were killed at 7 days after the last session, and the penile tissue analysed macroscopically and histologically. The results showed clearly that the model was efficient, creating a similar situation to that when applying ESWT in the human penis. All of the rabbits in groups 2 and 3 had haematomas and diffuse petechiae after ESWT, and only four had urethral and penile bleeding. Almost all macroscopic changes disappeared after 48 h and only one rabbit in group 3 after 7 days had a haematoma on the dorsal penile surface. The histology (assessed using haematoxylin and eosin staining) of the cavernous body of the penis showed: unchanged histology in group 1; in group 2 there was a dilated and congested vascular space in the cavernous body, with interstitial extensive bleeding in the dermis; and in group 3 there was an increase in interstitial fibrous tissue in the cavernous septum, with deposition of collagen fibres and thickening of the tunica albuginea. The present model was efficient in producing tissue injury in the normal penis when treated with ESWT, suggesting that this promising model should be considered for use future studies of Peyronie's disease.

Response of Bone Turnover Biochemical Markers to Extracorporeal Shock Wave Therapy in the Management of Long-Bone Nonunions

Although extracorporeal shock-wave therapy (ESWT)1 has been used extensively for treatment of nonunions of bone fractures (1), this treatment fails in many patients. Plain radiography remains the gold-standard approach for monitoring nonunion healing. Biochemical bone markers, however, may provide information regarding the effects of treatment earlier than radiography. Osteocalcin (OC) and bone-specific alkaline phosphatase (bALP) are used to monitor normal and delayed fracture healing (2). We investigated whether these biochemical bone markers can be used to distinguish between nonunions that respond to ESWT treatment and those that do not and to provide this information earlier than radiographic findings. Study participants were 34 patients [26 men and 8 women, mean (SD) age 42.5 (5.9) years] with tibial (22 patients) or femoral (12 patients) hypertrophic nonunions. This study was approved by our local ethics committee, and all subjects gave their written informed consent. All the patients underwent the same ESWT treatment, which consisted of 4 separate ESWT sessions at 1-week intervals, with 4000 impulses per session with an energy-flux density (EFD) of 0.40 mJ/mm2, provided by a an electromagnetic ESWT generator (Modulith SLK Storz Medical AG). The nonunion healing process was assessed …

Long-Term Results of Extracorporeal Shockwave Therapy for Peyronie's Disease

To analyze the long-term results in patients undergoing extracorporeal shockwave therapy (ESWT) for Peyronie's disease. Patients treated with ESWT (3000 shockwaves on a Storz Minilith SL lithotripter) for Peyronie's disease were included. The mean disease duration prior to treatment was 23.2 months (range 4-60 months). Penile angulation was measured before and after treatment by artificial vacuum induction of erection. Pain during erection was measured using a visual analog scale (VAS 0-5). The average number of ESWT sessions was 3.4 (range 2-9). The mean follow-up post-treatment was 44.1 months (range 42-48 months). Of 44 eligible patients, 38 patients (86.4%) were contactable for evaluation. Of the 38 patients, 10 (26%) subsequently underwent corrective surgery for failed ESWT. Of the remaining 28 patients, 18 (47% of the total) had a statistically significant reduction in angulation, with a mean reduction of 33.2 degrees +/- 14.4 degrees (SD) (range 10 degrees -75 degrees ) (P < 0.001). Nine patients (24%) obtained no benefit, and one had an increase in angulation of 10 degrees . Of the 24 patients with pain, 16 (66.6%) reported relief after ESWT, the mean reduction being 2.5 (range 0.5-4.0) on the VAS (P < 0.001). Of the 28 patients who had not undergone surgical correction, 18 (65%) reported erections suitable for intercourse; 14 (48%) were satisfied with ESWT, 8 (30%) dissatisfied, and 6 (22%) uncertain. Although one patient complained of some penile shortening, no other long-term adverse events were noted. Although a quarter of ESWT patients resorted to surgery, in the absence of other effective nonsurgical treatments, ESWT may provide a useful, safe, conservative management option. Extracorporeal shockwave therapy cannot yet be recommended as standard for Peyronie's disease, and randomized controlled studies are required to validate its efficacy and identify the subset of patients most likely to benefit.

An alternative non-invasive treatment for Peyronie's disease

Surgical correction of the deformity and plaque caused by Peyronie's disease has some important disadvantages and extracorporeal shockwave therapy (ESWT) emerged as a new promising therapy. We evaluated prospectively the efficacy and safety of the association of high dose vitamin E and ESWT as a non-invasive treatment for the disease. Twenty-five patients 42 to 68 years old (mean = 54) presenting penile deviation and sexual distress caused by Peyronie's disease were treated in a non-invasive manner. The time of penile deviation ranged from 16 to 52 months (mean = 30). All patients had previous unsuccessful treatment for Peyronie's disease. The angulation's deformity of the penis was assessed by photography at home. The patients received vitamin E (l.200 mg daily) during 3 months and underwent 3 to 6 sessions (mean = 3) of ESWT (3,000 to 4,000 shockwaves) at a power level of l to 2 at 1-week intervals. From 25 patients treated, 16 (64%) reported an improvement in penile angulation, with a mean reduction of 21 degrees (10 to 40). Eight patients reported improvement in their spontaneous erections. Overall, the patients presented only minimal bruising at the site of treatment and skin hematoma. Four patients presented urethral bleeding. The mean angulation after treatment in the control group was 48.67 degrees (30 - 70) and in the study group was 24.42 degrees (0 - 70), statistically significant. Considering the common complications and the unsatisfactory outcome of the surgical correction for Peyronie's disease, the association of high dose vitamin E and ESWT represents a good option for a non-invasive, effective and safe treatment of the penile deformity.

Extracorporeal Shockwave Therapy in the Treatment of Lateral Epicondylitis

0124 PURPOSE: To describe the outcomes of a cohort of individuals involved in a randomized control trial of extracorporeal shockwave therapy (ESWT) in the treatment of lateral epicondylitis (LE) not previously treated at least one year post-inclusion. METHODS: This study is a prospective cohort design. The initial trial was a doubleblind randomized control trial design. 60 subjects diagnosed with LE, who had never been treated for their LE were randomly allocated to receive 3 weekly sessions of real (total energy flux density range 0.03–0.17mJ/mm2) or sham ESWT. All subjects were taught a home forearm extensor stretch. Subjects were followed for 8 weeks postinclusion and were assessed for overall pain (visual analogue scale), and maximum pain-free grip strength. At the 8 week follow-up, all subjects were unblinded to their treatment allocation and subjects initially allocated to sham therapy were offered active therapy. Subjects who felt they might benefit from additional treatment sessions at the 8 week follow-up following initiation of active therapy were given 2 additional sessions. All subjects, regardless of allocation were followed for a minimum of one year post-inclusion. All subjects who received active therapy (whether initially or later crossed over) were pooled for analysis. RESULTS: Initial results for the first 20 subjects are presented in the table below (Interquartile range in parentheses):TableCONCLUSION: Initial results suggest substantial improvement in pain (one order of magnitude) and pain-free maximum grip strength over a 3-month period, and possible continued improvement over one year. It is speculated that there may be additional therapeutic benefit to additional treatment sessions beyond the standard manufacturer recommended 3 sessions. Full results for the full cohort out to one year will be presented. Supported by the Alberta Provincial Canadian Institutes of Health Research Bone and Joint Training Program and the Sport Science Association of Alberta.

Extracorporeal Shockwave Therapy in the Treatment of Lateral Epicondylitis

0124 PURPOSE: To describe the outcomes of a cohort of individuals involved in a randomized control trial of extracorporeal shockwave therapy (ESWT) in the treatment of lateral epicondylitis (LE) not previously treated at least one year post-inclusion. METHODS: This study is a prospective cohort design. The initial trial was a doubleblind randomized control trial design. 60 subjects diagnosed with LE, who had never been treated for their LE were randomly allocated to receive 3 weekly sessions of real (total energy flux density range 0.03–0.17mJ/mm2) or sham ESWT. All subjects were taught a home forearm extensor stretch. Subjects were followed for 8 weeks postinclusion and were assessed for overall pain (visual analogue scale), and maximum pain-free grip strength. At the 8 week follow-up, all subjects were unblinded to their treatment allocation and subjects initially allocated to sham therapy were offered active therapy. Subjects who felt they might benefit from additional treatment sessions at the 8 week follow-up following initiation of active therapy were given 2 additional sessions. All subjects, regardless of allocation were followed for a minimum of one year post-inclusion. All subjects who received active therapy (whether initially or later crossed over) were pooled for analysis. RESULTS: Initial results for the first 20 subjects are presented in the table below (Interquartile range in parentheses):TableCONCLUSION: Initial results suggest substantial improvement in pain (one order of magnitude) and pain-free maximum grip strength over a 3-month period, and possible continued improvement over one year. It is speculated that there may be additional therapeutic benefit to additional treatment sessions beyond the standard manufacturer recommended 3 sessions. Full results for the full cohort out to one year will be presented. Supported by the Alberta Provincial Canadian Institutes of Health Research Bone and Joint Training Program and the Sport Science Association of Alberta.

Extracorporeal Shock Wave Therapy (ESWT) in Patients with Chronic Proximal Plantar Fasciitis: A 2-Year Follow-up

The aim of this study was to compare the effect of extracorporeal shock wave therapy (ESWT) in patients with chronically painful proximal plantar fasciitis with a further conventional conservative treatment. Forty-seven patients (49 feet) with a previously unsuccessful nonsurgical treatment of at least 6 months were randomized to two groups. Heel cups had to be worn throughout the study. Group 1 (25 heels) was treated immediately with three sessions of ESWT (3000 shock waves/session of 0.2 mJ/mm2) at weekly intervals. The patients of group 2 (24 heels) continued nonsurgical treatment (iontophoresis with diclofenac and an oral nonsteroidal anti-inflammatory drug) for 12 weeks. After this period they were treated using the protocol of group 1. No significant difference of pain and walking time after further nonsurgical treatment (3 months) was seen in group 2. At 12 weeks after ESWT, the pain estimation on the visual analogue scale (VAS) for activities of daily living diminished significantly by 62.9% in group 1 and by 63.0% in group 2. The comfortable walking time had increased significantly in both groups. Two years after ESWT, pain during activities of daily living decreased by 94% in group 1 and by 90% in group 2 on the VAS and the comfortable walking time had increased significantly in both groups.

Paper #165 Sonographic evaluation of plantar fasciitis after

Paper #165 Sonographic evaluation of plantar fasciitis after

Paper #90 Extracorporeal Shock Wave Therapy (ESWT) in patients with painful, proximal plantar fasciitis

The aim of this study was to compare the effect of extracorporeal shock wave therapy (ESWT) in patients with chronically painful, proximal plantar fasciitis with a conventional conservative treatment. Forty-seven patients (49 heels) with a previously unsuccessful conservative treatment of at least 6 months were prospectively randomized to two groups with a random list. Treatment of group 1 (25 heels) started immediately after enrollment with three sessions of ESWT (3000 shock waves/session of 0.2 mJ/mm2) at weekly intervals. No local anaesthesia was applied. In the patients of group 2 (24 heels) conservative treatment was continued for 12 weeks. After this period they were treated using the protocol of group 1. Patients were followed up at 6, 12 and 24 weeks and 2 years after ESWT. A clinical investigation was performed regarding pain on a visual analogue scale ranging from 0 (no pain) to 100 (maximal pain) and the comfortable walking time. Statistical analysis was done with the non-parametrical Wilcoxon test for paired samples and the non-parametrical Mann-Whitney test for unpaired samples. No significant difference of pain (70.2 ± 22.4 to 70.2 ± 22.2) and comfortable walking time (0.3h ± 0.5 to 0.3h ± 0.5) after further conservative treatment (3 months) was seen (group 2). Six months after ESWT pain during activities of daily living decreased by 83% on the visual analogue scale (VAS) and the comfortable walking time had increased significantly in both groups (p < 0.01). Two years after ESWT pain during activities of daily living had decreased even more by 90% on the visual analogue scale compared to prior to ESWT and the comfortable walking time had increased significantly in both groups (p < 0.01). In our study we could not find any significant differences of pain and walking time after further conservative treatment of 3 months in patients with chronic proximal plantar fasciitis. After ESWT pain and walking time improved significantly.

EFFECTIVENESS OF EXTRACORPOREAL SHOCKWAVE THERAPY IN THE TREATMENT OF UNTREATED LATERAL EPICONDYLITIS (PRELIMINARY RESULTS)

PURPOSE To determine the effectiveness of extracorporeal shockwave therapy (ESWT) in the treatment of lateral epicondylitis (LE) not previously treated. METHODS This was a double-blind (evaluator and subject blinded) randomized control trial design. 60 subjects diagnosed with LE, who had never been treated for their LE (NSAID use was permitted) were randomly allocated (random permuted block randomization, envelope concealment) to receive 3 weekly sessions of real (total energy flux density range 0.03–0.17mJ/mm2) or sham ESWT. All subjects were taught a home forearm extensor stretch. Subjects were followed for 8 weeks post-inclusion and were assessed for overall pain (VAS), quality of life (EuroQoL questionnaire), and maximum pain-free grip strength. RESULTS Initial results for 20 subjects are presented in the table below (standard deviations in parantheses).Table: No Caption AvailableCONCLUSION Full results for all 60 subjects will be presented. Initial results suggest a higher magnitude of improvement in VAS pain score and quality of life in the ESWT therapy group compared to the sham therapy group. Supported by the Canadian Institutes of Health Research Training Program and the Sport Science Association of Alberta.

Evaluation of extracorporeal shock wave therapy in Peyronie’s disease

Objectives To evaluate the results of extracorporeal shock wave therapy (ESWT) in patients with Peyronie’s disease. Methods This study included 42 patients (mean age 55.4 years, range 32 to 72, SD 9.92) with Peyronie’s disease. The mean duration of disease was 16.5 months (range 3 to 60, SD 13.31). Before treatment, the degree of angulation was assessed artificially by injection of 10 to 20 μg alprostadil, and Polaroid photographs were taken. Patients were also questioned about pain on erection, whether sexual intercourse was possible, and the quality of erections. All were initially treated with three sessions of ESWT (3000 shock waves). After three sessions, patients who believed that improvement had resulted or who wanted to undergo additional treatment went on to have further sessions. The mean duration of follow-up was 5.9 months (range 2 to 18, SD 4.4), after which the results were analyzed. Results Those who believed that improvement in angulation had resulted were asked to provide Polaroid photographs to assess the improvement objectively. Six (14%) said that they had excellent results, 21 (50%) had significant improvement, 7 (17%) had slight improvement, and 8 (19%) had no change. Of the 25 who had pain on erection before treatment, 21 (84%) reported complete or near complete relief after treatment. Five patients said that the quality of the erections had improved after treatment. Eight patients complained of mild and one of severe pain during or immediately after treatment; 2 of these 9 patients had both pain and bruising. Conclusions The initial results with ESWT are promising, with minimal complications. The long-term results need to be evaluated.

Extracorporeal shock wave therapy in the treatment of Peyronie’s disease: experience with standard lithotriptor (siemens-multiline)

Objectives. To assess in a prospective study whether extracorporeal shock wave therapy (ESWT) using a standard radioscopic location lithotriptor is effective in the treatment of Peyronie’s disease. Methods. Fifty-four patients were included in this prospective study. Before and after treatment, the angulation was calculated by auto-photography. Pain severity was assessed by a visual analog pain scale. A self-evaluation questionnaire (International Index of Erectile Function) was used. All patients had symptoms (35 had pain during erection and 51 angulation greater than 20°). The mean disease duration was 16 months. The mean angulation before treatment was 48° (range 10° to 100°). Twenty-four patients had erectile dysfunction (questionnaire score less than 18). The Multiline Siemens lithotriptor was used. The plaque was located by palpation, and 1 mL of contrast agent was injected. Scopic visualization was used. Each patient received a minimum of one session of ESWT (3000 shock waves, 7 kJ) applied to a flaccid penis. Results. All patients completed the protocol. The tolerance and safety were excellent. Of the 35 patients with pain on erection, 31 (91%) noticed relief immediately after ESWT (mean reduction 2.9 on the visual analog pain scale) ( P <0.00001). For 29 patients (53.7%), an improvement in angulation (greater than 10°) was observed, with a mean reduction of 31° ( P <0.001). For patients with erectile dysfunction, only 6 (25%) had an increased questionnaire score (greater than 4). Twenty-five patients thought the plaque was smoother. Conclusions. ESWT with a standard lithotriptor (without the mobile arm) in Peyronie’s disease is a feasible, safe, and effective treatment for pain on erection and significantly improves the penile angle.

Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience.

To evaluate prospectively the efficacy of extracorporeal shock wave therapy (ESWT) as a conservative treatment for Peyronie's disease. After obtaining ethical committee approval, 37 patients with Peyronie's disease were treated using ESWT. Before treatment the degree of angulation was assessed by artificially inducing an erection with a vacuum device. The severity of pain on erection was assessed using a visual analogue scale (0-5). Each patient was treated with a minimum of three sessions of ESWT (3000 shock waves at an energy density of 0.11-0.17 mJ/mm2) at 3-week intervals. The results were analysed using the Wilcoxon signed-rank test. Of the 37 patients, 34 completed the protocol; the mean (range) duration of the disease was 19.43 (4-60) months and the mean follow-up 7.5 (5-11) months. Almost half (47%) of the patients reported an improvement in angulation, with a mean reduction of 29.3 degrees (10 degrees -60 degrees ) (P < 0.001); 12 of the 20 (60%) patients with pain on erection reported immediate relief, the mean reduction being 2.3 (1-4) on the visual analogue scale (P < 0.001). There was only minimal bruising at the site of treatment and no major side-effects were reported. ESWT is an effective and safe treatment for Peyronie's disease; the long-term follow-up and results are awaited.