madman
Super Moderator
ABSTRACT
Sufficient functional repair of damaged peripheral nerves is a big clinical challenge in terms of long-lasting morbidity, disability, and economic costs. Nerve damage after radical prostatectomy is the most common cause of erectile dysfunction (ED). In recent years, low-intensity extracorporeal shockwave therapy (LiESWT) has been explored to improve the outcomes of peripheral nerve repair and regeneration. Research indicated that the application of Li-ESWT after nerve surgery promoted nerve regeneration and improved the functional outcomes, underlined the mechanisms related to increasing of neurotrophic factors, Schwann cells activation, and cellular signaling activation for cell activation and mitosis induced by Li-ESWT. We searched PubMed for articles related to research on these topics in both in vitro and in vivo animal models and found numerous studies suggesting that the application Li-ESWT could be a novel treatment for ED induced by nerve injury and other disease-related to nerve injury.
Introduction
The efficient functional repair of damaged peripheral nerves is a big clinical challenge because they are vulnerable to injuries from crushing, stretching, compression, and avulsion and may result in long-lasting morbidity, disability, and economic costs.[1-3] The causes of peripheral nerve injury could be traffic accidents, tumor damage, viral infections, side effects of neurosurgery, and so on.[4] Injuries to the peripheral nerves can also occur in multiple clinical scenarios. For example, prostate cancer surgery often damages the corpus cavernous nerve, even with nerve-sparing techniques,[5] which eventually leads to erectile dysfunction (ED). Radical prostatectomy is the gold standard for early-stage prostate cancer but is also the most common cause of ED. The prevalence of ED is approximately 14%–90% because of nerve damage after radical prostatectomy.[6]
Recently, low-intensity extracorporeal shockwave therapy (LiESWT) has been successfully used in the field of regenerative medicine after its original introduction as urological lithotripsy. [18] In preclinical and clinical trials, Li-ESWT is currently applied to a wide range of medical indications, such as wound healing,[19] musculoskeletal disorders,[20] bone healing disturbances,[21,22] painful scars,[23] spastic hypertonia,[24] ischemic heart diseases,[25], and so on. More recently, studies focusing on the influence of ESWT on peripheral nerve proved that LiESWT could promote peripheral nerve regeneration after injury. [26,27] Although no clinical studies exist regarding the same, several experimental studies have investigated the use of Li-ESWT as an effective treatment after peripheral nerve repair and demonstrated very good outcomes. This study presents a systematic review of the available preclinical literature of the reported effects of Li-ESWT in penile and peripheral nerve regeneration and its potential clinical applications.
Pathogenesis of nerve injury and regeneration
Physical characteristics of shockwave
Effect of ESWT on peripheral nerve regeneration
Dosage effect of Li-ESWT on the peripheral nerve
Li-ESWT promotes peripheral nerve regeneration
Effect of Li-ESWT on neurogenic ED
Li-ESWT activates SCs
Li-ESWT induces neurotrophic factors
BDNF
NT-3
Effect of Li-ESWT on cellular signaling for cell activation and mitosis
ERK pathway
PERK pathway
Tropomyosin receptor kinase B pathway
In conclusion, there is significant evidence to prove that the application of Li-ESWT after nerve surgery promotes nerve regeneration and improves functional outcomes. The benefits of Li-ESWT in peripheral nerve regeneration and neurogenic ED may be owing to the increase in NFs, SC activation, and cellular signaling activation for cell activation and mitosis (Figure 1). Given the preclinical benefits in the absence of any negative side effects, Li-ESWT should be investigated clinically in humans as an adjunct therapy after nerve surgery.
Sufficient functional repair of damaged peripheral nerves is a big clinical challenge in terms of long-lasting morbidity, disability, and economic costs. Nerve damage after radical prostatectomy is the most common cause of erectile dysfunction (ED). In recent years, low-intensity extracorporeal shockwave therapy (LiESWT) has been explored to improve the outcomes of peripheral nerve repair and regeneration. Research indicated that the application of Li-ESWT after nerve surgery promoted nerve regeneration and improved the functional outcomes, underlined the mechanisms related to increasing of neurotrophic factors, Schwann cells activation, and cellular signaling activation for cell activation and mitosis induced by Li-ESWT. We searched PubMed for articles related to research on these topics in both in vitro and in vivo animal models and found numerous studies suggesting that the application Li-ESWT could be a novel treatment for ED induced by nerve injury and other disease-related to nerve injury.
Introduction
The efficient functional repair of damaged peripheral nerves is a big clinical challenge because they are vulnerable to injuries from crushing, stretching, compression, and avulsion and may result in long-lasting morbidity, disability, and economic costs.[1-3] The causes of peripheral nerve injury could be traffic accidents, tumor damage, viral infections, side effects of neurosurgery, and so on.[4] Injuries to the peripheral nerves can also occur in multiple clinical scenarios. For example, prostate cancer surgery often damages the corpus cavernous nerve, even with nerve-sparing techniques,[5] which eventually leads to erectile dysfunction (ED). Radical prostatectomy is the gold standard for early-stage prostate cancer but is also the most common cause of ED. The prevalence of ED is approximately 14%–90% because of nerve damage after radical prostatectomy.[6]
Recently, low-intensity extracorporeal shockwave therapy (LiESWT) has been successfully used in the field of regenerative medicine after its original introduction as urological lithotripsy. [18] In preclinical and clinical trials, Li-ESWT is currently applied to a wide range of medical indications, such as wound healing,[19] musculoskeletal disorders,[20] bone healing disturbances,[21,22] painful scars,[23] spastic hypertonia,[24] ischemic heart diseases,[25], and so on. More recently, studies focusing on the influence of ESWT on peripheral nerve proved that LiESWT could promote peripheral nerve regeneration after injury. [26,27] Although no clinical studies exist regarding the same, several experimental studies have investigated the use of Li-ESWT as an effective treatment after peripheral nerve repair and demonstrated very good outcomes. This study presents a systematic review of the available preclinical literature of the reported effects of Li-ESWT in penile and peripheral nerve regeneration and its potential clinical applications.
Pathogenesis of nerve injury and regeneration
Physical characteristics of shockwave
Effect of ESWT on peripheral nerve regeneration
Dosage effect of Li-ESWT on the peripheral nerve
Li-ESWT promotes peripheral nerve regeneration
Effect of Li-ESWT on neurogenic ED
Li-ESWT activates SCs
Li-ESWT induces neurotrophic factors
BDNF
NT-3
Effect of Li-ESWT on cellular signaling for cell activation and mitosis
ERK pathway
PERK pathway
Tropomyosin receptor kinase B pathway
In conclusion, there is significant evidence to prove that the application of Li-ESWT after nerve surgery promotes nerve regeneration and improves functional outcomes. The benefits of Li-ESWT in peripheral nerve regeneration and neurogenic ED may be owing to the increase in NFs, SC activation, and cellular signaling activation for cell activation and mitosis (Figure 1). Given the preclinical benefits in the absence of any negative side effects, Li-ESWT should be investigated clinically in humans as an adjunct therapy after nerve surgery.
