Site na ọgwụ gbasara mmekọahụ na San Diego
AKWỤKWỌ NDỊ ỌZỌ MMASỤ MMỤỌ ỌNWA
A ka na-aghọta nke ọma ụkpụrụ nke ọrụ mmekọahụ site na Central ụjọ usoro (CNS). A na-ahazi njikwa nke nrụpụta penile n'ime netwọk mgbasa ozi nke saịtị dị iche iche yana njikọ dị n'ime CNS na ụzọ neuronal kpọmkwem ka bụ nke enweghị nkọwa. Otú ọ dị, enweela ọganihu n'ịchọpụta isi ihe dị n'etiti ndị na-achịkwa nzaghachi mkpali mmekọahụ na ụmụ nwoke. Nnyocha na-eji positron emission tomography (PET) n'ihe gbasara ụmụ nwoke nwere ahụike achọpụtala ụfọdụ mpaghara ụbụrụ nke na-arụ ọrụ na nzaghachi nke mkpali mmekọahụ a na-ahụ anya. Ndị a na-agụnye cortex nke dị ala (nke dị n'akụkụ), insula aka nri, cortex n'ihu nke dị ala na aka ekpe na cingulate cortex; mpaghara ejikọtara na njikọ anya, nhazi nke ozi mmetụta na steeti mkpali, na nhazi nke ọrụ autonomic na neuroendocrine.
Nnyocha nnwale na ụdị anụmanụ egosila na ọ bara uru n'usoro na-akọwapụtawanye nke njikwa etiti. Karịsịa, mkpali nke medial preoptic area (MPOA) na paraventricular nucleus (PVN) n'ime hypothalamus mara na-akpali ụzọ akwara pro-erectile na oke. Mpaghara abụọ ahụ na-ahazi ma jikọta ozi sitere na akụkụ dị iche iche nke CNS, na-anata ntinye uche sitere na visual (occipital), tactile (thalamus), na mkpali olfactory (rhinencephalon) yana ntinye echiche (usoro limbic). Mmụba nke dopamine na oxytocin ejikọtawo na mmekọ nwoke na nwanyị na ndị neurotransmitters a na-eche na ha na-arụ ọrụ dị mkpa n'ịgbazi nzaghachi pro-erectile na MPOA na PVN, n'otu n'otu.
N'ụzọ dị iche, nucleus paragigantocellularis (nPGi) na ụbụrụ ụbụrụ na-enwe mmetụta mgbochi na mkpali mmekọahụ. akwara sitere na oru nPGi gaa n'akụkụ sacral nke eriri afọ wee hapụ serotonin. Edebere nke a dịka ihe kpatara SSRI (kpọmkwem ndị na-emechi ihe nchịkwa serotonin) na-akụda ọrụ mmekọahụ. N'ụzọ na-akpali mmasị, ebe ọ bụ na ndị ikom na-eji ọgwụ SSRI na-agwọkarị na-egosipụtakarị igbu oge ma ọ bụ egbochiri ejaculation, a na-ejikwa ọgwụgwọ SSRI mee ihe omume nke ejaculation akabeghị aka nke ọma. Locus coeruleus na-egosipụtakwa ntinye ihe mgbochi site na irighiri akwara ọmịiko nke na-ejikọta ya na hypothalamic nuclei yana eriri azụ. A na-eche na ịwepụ ntinye ọmịiko n'ihi mbelata ọrụ mpaghara coeruleus n'oge REM (mmegharị anya ngwa ngwa) ụra na-eche na ọ ga-eduga n'ọhụụ nke tumescence penile nke abalị.
Ọmụmụ ihe gbasara ahụ na arụ ọrụ ga-abawanye nghọta anyị gbasara sekit akwara dị n'ime CNS nke na-achịkwa nrụpụta penile. Ịkọwapụta ọrụ nke neurotransmitters na-aga n'ihu na-abụ ọrụ dị mgbagwoju anya, ebe ọ bụ na ha nwere ike ịkpata mmetụta dị iche iche dabere na saịtị a na-eme ihe na nkesa subtype nkesa n'ime obere mpaghara neuronal.
AKWỤKWỌ MMỤỌ MỤRỤ MỤRỤ MỤRỤ MỤRỤ MỤRỤ
Iwu Neurogenic nke erection Penile
A na-ahazi ọrụ erectile na amụ site na autonomic (parasympathetic na ọmịiko) yana ụzọ somatic (sensory na moto) na-aga n'anụ ahụ erectile na akwara perineal striated. Usoro atọ nke irighiri akwara dị n'akụkụ na-abanye n'ime amụ.
Na akwara ọmịiko (T10 - L2), na-ahụ maka detumescence na ịnọgide na-enwe flaccidity, na-arụ ọrụ na corpora, yana prostate na eriri afo olu site na akwara hypogastric. Postganglionic noradrenergic fibers na-agafe posterolateral na prostate na ihe a na-akpọ irighiri akwara nke Walsh iji banye corpora cavernosa medially. Adrenergic ụda dị oké mkpa n'ịmalite detumescence na ịnọgide na-enwe flaccid ọnọdụ nke amụ ebe ọ bụ na ire ụtọ akwara nke akwara na cavernosal trabeculae ga-anọgide na-arụsi ọrụ ike nkwekọrịta. Mgbochi nke uru ahụ dị nro nke cavernosal trabecular gaa na norepinephrine bụ ndị na-anabata adrenergic alfa-1 na-ebute ya. pre-junctional alpha-2 adrenergic receptors na adrenergic irighiri akwara na-egbochi neurotransmission ma nye nzaghachi nzaghachi na-adịghị mma na-achịkwa onwe ya maka norepinephrine zoro ezo. Iri irighiri akwara cholinergic na-arụ ọrụ na ndị na-anabata muscarin tupu junctional iji gbochie ọrụ akwara adrenergic.
Ọ ga-ekwe omume na adrenergic ahaghị nhata n'ihu vasoconstriction na-emebi nrụpụta. Ọ bụ ezie na ụfọdụ ihe na-enye aka na enweghị ahaghị nhata a ka amabeghị, ịka nká na/ma ọ bụ ọnọdụ ọrịa emetụtara nwere ike ime ka usoro nhazi nke ụdị subtypes adrenergic kpọmkwem, na-ebute nrụpụta dị elu maka ọrụ norepinephrine. Ebe norepinephrine bụ isi modulator nke ọrụ erectile, ọ bụ ihe ezi uche dị na ya na ndị na-emegide ndị na-anabata alfa-adrenergic nwere ike ịba uru na ọgwụgwọ ED. Ahụmahụ ụlọ ọgwụ na ọgwụ ndị dị ka yohimbine na phentolamine egosila ịdị irè dị iche iche na ndị ikom nwere ED. Ọrụ nke ndị na-anabata alfa-adrenergic na physiology nke penile erection na-enyocha nke ọma n'ebe ọzọ.
Iri akwara parasympathetic, nke sitere na akụkụ intermediolateral nke S2 - S4 akụkụ azụ azụ, na-enye ntinye ihe na-akpali akpali na amụ ma na-ahụ maka vasodilation nke penile vasculature na nrụzi na-esote. Na-apụ site na sacral foramina, irighiri akwara ndị a na-aga n'ihu n'akụkụ akụkụ na rectum dị ka akwara pelvic na synapse na pelvic plexus na post-ganglionic nonadrenergic, noncholinergic (NANC), nke na-aga n'ime akwara cavernous na corpora cavernosa. Vasoactive intestinal peptide (VIP) na nitric oxide (NO) bụ neurotransmitters NANC abụọ na-ejikọtakarị na otu irighiri akwara na anụ ahụ penile. Agbanyeghị, ọrụ VIP dị ka onye modulator nke erection penile ka amabeghị ebe ọ bụ na nsonaazụ nnwale na peptide a na ọrụ erectile adabaghị. Intracavernosal nchịkwa nke VIP n'ime anụmanụ na ụmụ mmadụ arụpụtala ihe dị iche iche, sitere na enweghị mmetụta ruo n'eleghị anya tumescence ruo n'ikike zuru oke. Ọzọkwa, enweghị ndị mmegide a kapịrị ọnụ ma dị irè maka VIP na-egbochi nyocha nnwale gbasara ọrụ ọ na-arụ n'ọrụ erectile.
Onye ogbugbo izizi nke ntinye parasympathetic NANC bụ NO. Ikike nke NO, gas na-arụ ọrụ nke ukwuu na nke anaghị akwụsi ike, iji chịkwaa ọtụtụ ọrụ physiological na anụ mamma ka apụtala ìhè n'ime iri afọ abụọ gara aga. Yana carbon monoxide, NO bụ molekul pụrụ iche na-eme ihe nwere njirimara nke ozi nke abụọ nke intracellular nke na-emegide atụmatụ nhazi ọkwa gara aga. O doro anya na a na-emepụta ya na ihe achọrọ na-enweghị obere ma ọ bụ enweghị nchekwa ma ọ na-arụ ọrụ ozugbo enzyme soluble (guanylate cyclase) kama ịbụ ihe na-anabata "ọdịnala". Ọ dịghị nke nitric oxide synthase (NOS) na-emepụta nke na-eji amino acid L-arginine na oxygen molecular dị ka ihe na-emepụta NO na L-citrulline. Ọ BỤGHỊ nwere ike ịfefe membranes plasma ngwa ngwa ịbanye n'ime mkpụrụ ndụ e lekwasịrị anya ebe ọ na-ejikọta akụkụ heme nke guanylate cyclase soluble. Nke a na-arụ ọrụ nke guanylate cyclase na-akpali mmepụta nke cGMP site na ntinye nke protein kinase na-adabere na cGMP nke na-achịkwa ihe omume intracellular nke na-eduga na ntụrụndụ dị nro nke trabecular. A na-achịkwa ọkwa nke cGMP site na phosphodiesterases, nke na-akụda cGMP ma kwụsị mgbaàmà. Sildenafil (Viagra), tadalafil (Cialis) na vardenafil (Levitra) bụ ndị nwere ike, ndị na-ahọrọ na ndị na-agbanwe agbanwe nke ụdị phosphodiesterase 2, bụ isi enzyme maka cGMP hydrolysis na penile erectile anụ ahụ. Mgbochi nke enzyme a na-eduga n'ịbawanye ọkwa cGMP intracellular na nkwalite nke ntụrụndụ dị nro na nzaghachi nke mkpali na-eme ka ụzọ NO/cGMP rụọ ọrụ. Ọrụ dị otú ahụ nwere ike ịkọwa uru na-aga nke ọma nke ndị ọrụ ndị a na ọgwụgwọ nwoke ED.
N'oge na-adịbeghị anya, ọ pụtara ìhè na Ọ DỊGHỊ na-emekọrịta ihe ozugbo na ebumnuche cellular ndị ọzọ gụnyere ndị na-anabata ya, ọwa ion na nfuli, nke nwere ike gbanwee nkwekọrịta cell muscle dị nro, na-adabere na ụzọ cGMP. Ya mere, na mgbakwunye na guanylate cyclase, NO nwere ihe mgbaru ọsọ intracellular ndị ọzọ, nke nwere ike ịrụ ọrụ na nhazi nke vascular na trabecular smooth muscle contractility.
Ọrụ nke akwara NANC nwere ike gbanwee site na irighiri akwara cholinergic, nke na-enyere aka nonadrenergic, ntụrụndụ noncholinergic site na-akpali akpali njikọ na ntọhapụ nke NO na ndị ọzọ vasodilatory neurotransmitters dị ka VIP. Ya mere, ntọhapụ nke acetylcholine nwere ike ịhazi mwepu nke ntinye adrenergic na mmụba nke ntinye NANC site na ijikọta ndị na-anabata muscarinic pre-junctional na adrenergic na NANC irighiri akwara. N'ọnọdụ ụfọdụ ọrịa dịka ọrịa shuga, ike nke corpus cavernosum na-emepụta ma hapụ acetylcholine na-ebelata. Usoro ndị dị otú ahụ nwere ike bụrụ akụkụ ụfọdụ maka ọrụ erectile mebiri emebi metụtara ọrịa shuga. Iri akwara parasympathetic na-adịkwa ngwa ngwa n'oge usoro ịwa ahụ, dị ka mgbatị nke abdominoperineal nke ikensi na prostatectomy radical.
Iri irighiri akwara pudendal gụnyere moto efferent na ihe mmetụta mmetụta na-emetụta akwara ischiocavernous na bulbocavernous yana penile na perineal akpụkpọ. Ahụ cell neuron moto nke Pudendal dị na oghere Onuf nke akụkụ S2-S4. Nri akwara pudendal na-abanye na perineum site na obere sciatic notch na azụ azụ nke ischiorectal fossa ma na-agba ọsọ na Alcock's canal (pudendal canal) n'akụkụ azụ nke akpụkpọ ahụ perineal. N'oge a, ọ na-ebute irighiri akwara perineal nwere alaka na scrotum na irighiri akwara na-enye mpaghara akụkụ akụkụ nke dị ala. Iri akwara azụ nke amụ na-apụta dị ka ngalaba ikpeazụ nke akwara pudendal. Mgbe ahụ, ọ na-atụgharị anya n'akụkụ ogwe penile azụ azụ, n'akụkụ akwara azụ azụ. Ọtụtụ fasiklị na-amapụ nke ọma, na-ebunye ọnụ akwara ndị na-eme ihe na nke mmetụta n'akụkụ azụ nke tunica albuginea na akpụkpọ nke ogwe penile na amụ glans.
Ndị Modulators na-abụghị neuronal nke Penile erection
Na mgbakwunye na usoro neurogenic, ọ pụtara ìhè na ihe paracrine / autocrine mpaghara, nke nwere mmetụta vasoactive na / ma ọ bụ trophic, nwere ike imetụta ọrụ nke uru ahụ dị nro na amụ. Ndị a gụnyere endothelins, prostanoids, nitric oxide na oxygen.
Endothelin-1 (ET-1), onye so na ezinụlọ endothelin nke peptides, bụ otu n'ime vasoconstrictors kachasị ike nke akọwara. Dị ka nitric oxide, ntọhapụ endothelin sitere na mkpuchi mkpuchi nke akụkụ vaskụla nwere ike ịkpalite site na nrụgide shiee. Otú ọ dị, a maara ntakịrị ihe gbasara usoro physiological ma ọ bụ cellular, nke na-achịkwa mmepụta ya. N'ime mmadụ corpus cavernosum, ET-1 na-arụ ọrụ site na endothelium ma na-ebute mkpụkọ siri ike nke corpus cavernosum dị nro. Ma isi subtypes nke endothelin receptors (ETA na ETB) ka achọpụtara na penile corpus cavernosum ma na-ekesa na ma endothelium na anụ ahụ dị nro. A na-atụkwa aro na endothelin nwere ike ịkpata mmetụta vasodilator na obere mkpokọta site na ụdị mmekọrịta "dị elu" nke onye na-anabata ETB, nwere ike site na-akpali akpali NO mmepụta. Agbanyeghị, mkpa usoro a na nrụpụta penile ka edobeghị anya. N'ụdị ọrịa oke bekee, ndị na-anabata ETB na penile corpus cavernosum bụ ndị a na-ahazi na oke bekee na-arịa ọrịa shuga na alloxan na-achịkwa ya na hypercholesterolemic Watanabe rabbits. Na mgbakwunye, a kọwapụtara ọkwa endotthelin plasma dị elu na ma ndị ọrịa mamịrị ma ndị na-abụghị ndị ọrịa mamịrị nwere arụ ọrụ erectile. Ya mere, endothelin nwere ike inye aka na mmezi nke penile flaccidity site n'inye ụda na-adịgide adịgide na akwara trabecular dị nro na mgbanwe na mmepụta endothelin nwere ike ime ka arụ ọrụ erectile kwụsị. E mepụtala ọtụtụ ndị na-anabata endothelin subtype, mana enyochabeghị arụmọrụ ha na nchekwa ha na ọgwụgwọ ED nke ọma.
Na mgbakwunye na akwara NANC, vaskụla endothelium na-emepụta ma na-ahapụ nitric oxide. Vasodilators dị ka acetylcholine na bradykinin na-eme ihe site na ijikọ ndị na-anabata akpụkpọ ahụ ha na ịba ụba Ca2 + intracellular n'ime sel endothelial. A na-amakwa ihe mkpali anụ ahụ, dị ka mgbakasị ahụ ike, na-eme ka ọ bụrụ na ọ dịghị mmepụta na endothelium. N'ime amụ, NO mmepụta nke shear site na endothelium yikarịrị ka ọ ga-eme n'oge mmalite nke nrụpụta mgbe ọbara na-eruba n'ime ahụ cavernosal na-abawanye ngwa ngwa. Ụdị omume nke endothelium enwetara NO yiri akwara-enwetara NO, dị ka akọwara na ngalaba gara aga.
Prostanoids (eicosanoids, prostaglandins) bụ carbon iri abụọ na-emepụta site na omume cyclooxygenases na nkịtị precursor arachidonic acid na ma endothelial na ire ụtọ mkpụrụ ndụ nke corpora cavernosa. Prostanoids na-arụ ọrụ na mpaghara ma na-arụ ọrụ trophic na tonic n'ụzọ autocrine na paracrine. Ọ bụ ezie na kpọmkwem ọrụ physiologic nke prostaglandins na nrụpụta penile ka akọwapụtaghị nke ọma, ihe akaebe nnwale na-egosi na ha nwere ike ịrụ ọrụ dị mkpa na nhazi nke mmepụta matrix extracellular. Ọzọkwa, mmetụta mgbochi-platelet aggregating nke PGI2 (prostacyclin), dị ka NO, nwere ike dị mkpa na igbochi coagulation nke ọbara, ebe ọ bụ na ọbara eruba n'ime cavernosal ozu bụ nke na-erughị eru n'oge zuru ezu penile tumescence. Ngwakọta prostanoid ise bụ isi na-arụ ọrụ na amụ bụ prostaglandins PGD2, PGE2, PGF2?, PGI2 na thromboxane A2 (TXA2). Prostanoids nwere ike ịkpalite ma izu ike na mkpụkọ na penile corpus cavernosum. PGE bụ naanị prostaglandin endogenous nke na-egosi na ọ na-eme ka ahụ ahụ dị nro nke trabecular mmadụ nwee ntụrụndụ; ndị ọzọ na-akpata mkpọchi ma ọ bụ enweghị mmetụta na ụda akwara dị nro. Enwere otu isi ise nke ndị na-anabata prostanoid a na-akpọ DP, EP, FP, IP na TP, nke na-edozi mmetụta nke PGD, PGE, PGF, PGI na thromboxane, n'otu n'otu. Enwere ike ịkọwapụta ọtụtụ ọrụ, mmetụta dabere dose nke prostanoids site na njikọta nke subtypes nnabata na isoforms na sistemụ ozi nke abụọ dị iche iche. N'ụlọ ọgwụ, e mepụtara prostaglandin E1 (alprostadil) dị ka ọgwụ intracavernosal injectable FDA nke mbụ kwadoro maka ọgwụgwọ nwoke ED.
Ọgba aghara oxygen na-arụ ọrụ dị mkpa n'ịhazi nrụpụta penile. Ntụle nke ọbara cavernosal PO2 na ndị ọrụ afọ ofufo nke mmadụ na-egosi na esemokwu ikuku oxygen na-agbanwe ngwa ngwa site na venous (~ 35 mm Hg) ruo ọkwa arterial (~ 100 mm Hg) n'oge mgbanwe site na flaccid gaa na steeti kwụ ọtọ. Ịkwado ọgba aghara ikuku oxygen mgbe niile bụ ihe dị oke mkpa n'ọtụtụ anụ ahụ nke ahụ mana amụ bụ naanị akụkụ ahụ, nke na-agbanwe site na venous gaa n'ọgba aghara ikuku oxygen n'oge ọ na-arụ ọrụ nkịtị. Mgbanwe a bụ ihe ndabere nke usoro nhazi pụrụ iche nke na-eji uru nke enzymes synthetic bụ isi, nke na-eji oxygen molekụla dị ka ihe na-emekọ ihe. Ọ BỤGHỊ synthase na prostaglandin synthase bụ ihe atụ abụọ amụrụ nke ọma nke klas nke enzymes nke a maara dị ka dioxygenases. Na obere ikuku oxygen erughị ala, tụrụ na flaccid ala nke amụ, njikọ nke NO na-egbochi, na-egbochi trabecular ezigbo muscle ntụrụndụ. Mgbochi a nke NO mmepụta nwere ike dị mkpa maka mmezi nke penile flaccidity. Na-eso vasodilation nke akwara ndị na-eguzogide ọgwụ, mmụba nke akwara akwara na-ebuli esemokwu oxygen. N'ime ikuku oxygen na-emewanyewanye, akwara autonomic dilator na endothelium na-enwe ike ịmepụta NO, na-eme ka ahụ ahụ dị nro dị nro na trabecular. A na-ahazi njikọ nke prostanoids n'otu aka ahụ na flaccid na steeti kwụ ọtọ. Ya mere, esemokwu oxygen nwere ike ịhazi ụdị vasoactive bekee dị na akwa vaskụla a. N'ebe ikuku oxygen dị ala, norepinephrine na nkwụsị nke endothelin nwere ike ịmalite, ebe ọ bụ na ikuku oxygen dị elu, NO na prostaglandins na-emepụta n'ihi nnweta oxygen molecular nke a chọrọ maka njikọ ha.
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