Erectile Faletonu: O se Iloiloga o Auiliiliga Togafitiga Filifiliga mo Maualuga Maualuga (2019)

puna: Lautusi o le Restorative Medicine, Volume 8, Numera 1, 16 Fepuari 2019

tusitala: Retzler, Kathryn

ABSTRACT

Erectile afaina (ED) taatele i le matua. I le taimi muamua o togafitiga ED na ofoina atu e le tele o urologists, ae o le faamaoniga ma le lautele o le faʻaaogaina o le phosphodiesterase inhibitors ua mafai ai e fomaʻi ona vaaia fomaʻi togafitiga. E ui ina tele, multicenter faʻataʻitaʻiga faʻataʻitaʻiga ua faʻaalia le aoga ma le saogalemu i nei vailaʻau, ae le aoga i le 30-35% o tamaloloa, e ono mafua ai itu-afaina, ma e le faʻaleleia ai le tulaga o loʻo i lalo. O le malamalamaaga maeʻaeʻa o le erectile physiology ma mafuaʻaga o le ED ma se auiliiliga o togafiti o togafiti e faʻafetaui uma mea taua e ono sili atu aoga nai lo le puleaina o vailaau faʻafomaʻi ma ono faʻaleleia atili vaega o le mafaufau ma le soifua maloloina tino i tala atu o faʻafitauli.

FAATOMUAGA

Erectile afaina (ED) - le le mafai ona atiaeina ma tausia se fausiaina o se fale ua lava mo le tui - e taatele i le matua. E tusa ma le 40% o tamaloloa 40 ma 70% o alii 70 e iai ni ituaiga o ED.1 O loʻo fesoʻotaʻi le ED ma le tele o tulaga o le tino, atonu o se tuʻuga o le metabolic poʻo faʻamaʻi vaskular, ma afaina ai le soifua maloloina psychosocial. Phosphodiesterase ituaiga 5 inhibitor (PDE5i) o le pito sili ona taatele muamua laina togafitiga mo ED. O faʻataʻitaʻiga tetele e tele faʻataʻitaʻiga ua faʻaalia le aoga ma le saogalemu i nei vailaʻau; ae ui i lea, latou te le aoga i le 30–35% o tagata gasegase,2 ono aʻafia ai ni aʻafiaga, ma aua neʻi faʻapopoleina ai ni mea faʻavae. Malamalama lelei togafiti mo ED e taulai atu i mea uma saofaga mafai sili atu ona aoga nai lo le puleaina vailaau ma mafai faaleleia atili vaega o le mafaufau ma le soifua maloloina faaletino i tala atu o faafitauli erectile.

O LE SILI O ANATOMI MA FISIOLOGI O LE ERECTIONS

O le ED e tupu mai i le tele o gaioiga, lavelave ia faʻafitauli e aofia ai neura, faʻaiuga, ma le endocrine. O se faavae iloiloga o le anatomy ma physiology o faʻavae o le a maua ai se faʻavaʻa e malamalama ai i le pathophysiology ma le talafeagai mo togafitiga togafitiga (Ata 1). O le faʻatulagaga o le peni e aofia ai ni vavaeʻese sela ua aliaʻe (corpora cavernosa) o loʻo faʻatautaia le umi o le penile ma le korpus spongiosum o siomia ai le urethra. Penisani pepa o le faʻailogaina o le autonomic (agaalofa ma parasympathetic) ma somatic (sensory ma afi) vaega o le tino popole. Ua popole neula oso mai T11 – L2 ma ua anti-erectile, pulea ejaculation ma detumescence. Parasympathetic neura tulai mai i le S2 – S4 ma e pro-erectile. O neula o le agavaʻa ma le parasympathetic e fefiloi e fausia ai neura saua e ulu atu i le corpora cavernosa, corpus spongiosum, ma glans penis, faatonutonu tafe toto i le taimi o fausiaina. O le neula o le pudendal e maua ai lagona i le pelvis atoa ma le faʻatino gaioiga i uma sphincters, pelvic floor, ma le malo maso.

O loʻo faʻatinoina le faʻatulagaina o alatoto, alatoto ma neura.

Ata 1:

O loʻo faʻatinoina le faʻatulagaina o alatoto, alatoto ma neura.

O alatoto i totonu o le pudendal e maua ai le tafe toto i le penis, ma faʻamasani i le bulbourethral, ​​dorsal, ma cavernosal arteries. O le matataitulagi e ui i le loloto o le penile (Buck) fasia, e tuʻuina mai le pulu o le peni ma le penile urethra. O le alofaga alofaga e fealuaʻi i le va o le faʻaaliga o le neura ma le loloto o le vavao o le faʻasoasoaina o lavalava tafatafa na o mai faatasi ma le circumflex alatoto ma lala tumau i le glans. O le loloto o le penile poʻo le cavernosal artery e ulufale i le corpus cavernosum i le pu ma tafe le umi o le penile, e maua ai le helicine arteries faʻapitoa.

Feusuaiga faaosofia faaosoosoga parasympathetic neura e tatala acetylcholine. I totonu o le endothelial sela o loʻo ufiufi arteries penile, nitric oxide synthase (NOS) e mafua ai le faʻaaogaina o le L-arginine i le nitric oxide (NO) ma L-citrulline. LEAI gaioi guanylate cyclase i le corpora cavernosa ma spongiosum, lea e faʻaopopoina ai le faʻateleina guanosine monophosphate (cGMP) e tau atu ai i le faʻaolaina o le musele moli vasular, vasodilation, ma faateleina le tafe toto. Telefoni faʻatumu ma faʻalautele le faiga sinusoidal mafua ai le mailei o le toto e ala i le okaina o le venous plexuses ma le tunica albuginea, ma mafua ai toetoe lava atoa atoa o le afu mai fafo. Intracavernosal faʻamalosi e oʻo atu i le 100 mmHg i le faʻatuina atoa. Ischiocavernous maso faʻamalosia toto-tumu cavernosa o maso perineal konekarate mafua ai faʻamalosia mulimuli e oʻo atu i le selau selau mmHg. Ina ua uma ejaculation, le toe tatalaina o le neurotransmitter ona o le agaalofa o neula ma le phosphodiesterase enzymes talepeina cGMP e tau atu i detumescence ma flaccidity (Ata 2).

Physiology o faʻatuina.

Ata 2:

Physiology o faʻatuina.

Ach, acetylcholine; cGMP, sikoa guanosine monophosphate; LEAI, nitric oxide; PDE, phosphodiesterase; SNS, agaalofa agavale.

FAALOGAINA O LE LEAI O SE FESOASOANI

Ole auiliiliga ole iloiloga ole ED e manaʻomia le talaaga atoa, faʻaaogaina o fesili fesiligia, suʻega o le tino ma le galuega. Faʻataʻitaʻiga, pei o le duplex doppler ultrasound, penile arteriography, ma MRI e tatau ona faia e se urologist ma faʻapolopolo mo ono ono faia taotoga.

TALAFAASOLOPITO

O le suʻesuʻeina lelei o le talaʻaga e maua ai le avanoa e faʻailoa ai mafuaʻaga uma / saofaga mea e fesoʻotaʻi ma ED. E tusa ai ma mea tau mafaufau, ole fesili e uiga i mafatiaga o loʻo iai nei ma faʻafitauli e taua tele.

O le tagata lava ia-foliga mai ma feusuaiga masani faʻamoemoeina e masani ona le amanaʻia mataupu pe a avea se tala faʻatauaʻi, ae matua afaina ai feusuaiga. O iʻuga mai le atinaʻeina ma le faʻamaonia o le Male Genital Self-Image Scale (MGSIS) lea na faʻamatalaina tamaloloa i le 18–60 tausaga, na iloa ai o tamaloloa e sili atu a latou itupa tutusa ua lipotia ED itiiti ma ED 20% o alii sa le faʻamalieina i latou lapoa peni.3 O tama e i ai le leaga o le tino lava ia-mafaufau e ono fesiligia pe faʻapefea ona faʻatusatusa a latou pene faʻatusa i isi alii. O faamatalaga a Alfred Kinsey e uiga i le 2500 tamaloloa na lipotia ai le averesi o le umi o le peni, 1–4 inisi ma le averesi o le faʻatuina o le peni, 5-6.5 inisi. O le mea e malie ai, o tane e faʻapea e manatu maualalo le latou penisini faʻatusatusa i le faʻatatauina moni.4

Talanoaina faʻamoemoega e uiga i taimi masani o gaioiga faʻafeusuaʻiga e talafeagai mo aliʻi e maualalo le libido, lagona o feusuaiga le le lava, poʻo le fia iloa e uiga i latou feusuaiga faʻatusatusa pe a faʻatusatusa ma isi alii. Faʻamaumauga o faʻamatalaga o feusuaiga faʻatapulaʻa e faʻatapulaʻaina. Tasi AARP suesuega o 1670 alii ma tamaitai luga o le 45 tausaga lipotia o 41% o alii i latou 50s, 24% o alii i latou 60s, ma 15% o alii i latou 70s fai feusuaiga a itiiti mai tasi i le vaiaso (toe fai nei fuainumera - 59% o alii i latou 50s, 76% i latou 60s, ma 85% o alii i lo latou 70s faia feusuaiga faʻaiti nai lo faʻatasi i le vaiaso).5 O le International Society for Sexual Medicine (ISSM), lipotia faʻaiuga mai le Kinsey Institute's 2010 National Survey of Sexual Health and Behavior, na maitauina na o lalo ifo o le afa o alii faaipoipo faʻaipoipoga o le 25-49 na faia feusuaiga i ni nai taimi i le masina i vaiaso taʻitasi, o le sa maualuga maualuga i soʻo se matua tausaga.6 Ole isi suʻesuʻega na lomia e le ISSM na suʻesuʻe ai aliʻi ma tamaʻitaʻi e silia ma le 50 tausaga le matutua, naʻo le 20-30% o aliʻi ma tamaʻitaʻi o loʻo tumau pea le malosi i le 80s o latou tausaga.7

O ponokalafi faʻaaogaina o se mataupu e ono le manaia mo fomaʻi le talanoaina ma o latou tamaʻitaʻi maʻi. E ui o le faʻaiʻuga o vaisu o ponokalafi e feteʻenaʻi, o loʻo tele lava faʻamaoniga e fesoʻotaʻi ai le tele o taimi o ponokalafi faʻaaogaina ma se aʻafiaga i le faʻamalieina o le feusuaʻi faʻamaliega, faʻaipoipoga ma le fiafia, ma feusuaʻiga feusuaiga e aofia ai le maualalo le libido ma ED.8-11 Initaneti ponokalafi maua ai le leai o se mea fou ma se on-demand video foliga lea e ono tupu ai feusuaiga e faʻaosofia ai, faigata ai mo tamaloloa i le suiga i mea moni olaga.12 Leai se faʻamaonia suʻesuʻega meafaigaluega e faʻailoa ai ponokalafi-fesoʻotaʻi faigata e aofia ai ED ua atiaʻe. Ina ua uma ona fesiligia e uiga i le faʻafiafia o ponokalafi faʻaaogaina, e tatau ona fesiligia e le au fomaʻi le tomai e faʻatino ma faʻatumauina le fausiaina i le taimi o feusuaʻiga feusuaiga ma masturbation e aunoa ma ponokalafi faʻaaoga pe toe manatua. Afai e manaʻomia le manatua o ata ponokalafi e manaʻomia e maua ai le faʻatulagaina lelei, e avea ma faʻafitauli le ponokalafi-faʻatupuina e ED.

FAAMAONIA FESILI

Faʻamaonia fesili fesili e fesoasoani i le suʻesuʻeina mo le ED. O le fesili masani ona faʻaaogaina i le nofoaga faʻapitoa ma i faʻasalalauga faʻasalalau o le 15-mea International Index of Erectile Function (IIEF-15), faʻamaonia i 32 gagana.13 O le puʻupuʻu o faʻamatalaga, o le IIEF-5, poʻo le Sexual Health Inventory for Men (SHIM) fesili e mafai foi ona aoga mo faʻaiʻuga ma mataitu togafitiga lelei.14,15

TUSI FAʻAALIGA

O suʻega faʻaletino e tatau ona aofia ai se penile ma suʻega faʻapipiʻi, atonu o le malosi o le maʻau ole pelvic (e ala ile suʻega faʻainumera), toto maualuga, faʻamaoniga o faamaʻi o le fatu, maualuga, mamafa, ma le sulugatiti o le sulugatiti.

GALUEGA

Faʻavae i luga o talaʻaga ma faʻataʻitaʻiga tino, suʻesuʻega faʻataʻitaʻi e mafai ona aofia ai vaega metabolic ma lipid, anapogi iniseti, hemoglobin A1C, afaina mata e pei o hsCRP, numera ma le leai o testosterone, tiroid tofotofoga, ma, i alii talavou ma le masalosalo hypogonadism, luteinizing hormone ma prolactin .

MAFAUFAU MA FAʻAFITAULI FAʻAMATALAGA

Mafuaaga ma saofagafa mafuaʻaga mo ED mafai ona sili atu. E aofia ai mataupu tau le mafaufau, faʻafitauli tau le mafaufau, soona o ponokalafi le faʻaaogaina, faʻafitauli o le endocrine, vailaʻau aafiaga itu, ma suiga o faʻasoesa.

PSYCHOGENIC

O le taua o le popole, faʻafitauli o le soʻotaga, faʻanoanoaga, popolega, ma faʻafitauli o le atuatuvale i tua atu e mafai ona fesoasoani uma i le ED. Faatinoga popole, muamua faamatalaina e Masters ma Johnson i le 1970,16 o le le mafai ona ausia se faʻavae ona o mea ua tuanai ma ED. Faʻasalaga feusuaiga, aemaise ED ma le faaitiitia o feusuaiga manao, ua matua faateleina lava i tama veterans ma le post-traumatic popolevale tulaga.17 Psychogenic ED e masani lava tupu i le taimi o feusuaʻiga ma masani masani erectile gaioiga i le taimi o masturbation. E mafai ona faʻafuaseʻi le amataga, soʻosoʻo ma le faʻamaʻi e pei o le leai o se galuega, maliu o se aiga, poʻo ni faʻafitauli tau tupe. Ole masani ile po ole taeao e masani ai.

NEUROLOGICAL

O le limic system, e aofia ai ma le amygdala; hippocampus; ma dentate ma cingulate gyri, o se tasi o pito sili ona leva o le faiʻai e taatele i mamele uma. O lenei faiʻai itulagi faʻatonutonu lagona ma taumafai e aloese mai le tiga ma saili fiafia. Suesuega fautua mai o feusuaiga-fiafia visual stimulus faʻamalosia le amygdala ma hypothalamus sili atu i alii nai lo i fafine.18 Faʻamatalaga mai le amygdala e malaga i le ventral striatum, o se vaega tele o le basal ganglia e galue o se vaega o le faʻailoga. O le nucleus accumbens totonu o le ventral striatum o loʻo iai se tele o le tele o dopaminergic neurons ma e manatu o le nofoaga o le fiafia o le faiʻai. Ole Dopamine signaling o laʻasaga taua i feusuaiga faʻaosofia ma faʻamalosia. Faatoagaina o dopamine talimalo i lumbosacral parasympathetic neura o le spinal maea faʻafaigofie faʻatautaiga.19

Tulaga e faʻalavelavea ai le masani dopamine faailogaina poʻo le neurotransmission, poʻo e mafai ona faʻaleagaina ai le totonugalemu o le tino, mo se faʻataʻitaʻiga, Parkinson faʻamaʻi, sclerosis tele, maʻi suka, poʻo le stroke, mafai foi ona mafua ai le ED. O le tele o manuʻa ua afaina i le taimi o le prostatectomy e taitai atu ai i le ED i le silia ma le 50% o tamaloloa.20 O le tietie uila mamao e mafai ona faʻamalosia le pudendal neura ma alatoto i le va o le nofoa ma le faʻafeiloaʻi, faʻatapulaʻa le tafe toto ma le okesene i le penis.21,22 E ono maua e tagata faimalaga le le tumau ED ma le numera o le tino; ae ui i lea, latou te ono le lamatia sili atu ile ED. Faʻaiʻuga o se suʻesuʻega lata mai o le au 5000 taʻalo afeleti na faʻaalia ai o tagata tiʻetiʻe uila e pei lava ona masani ai i le ED o aau ma tamoʻe.23

FAIGA FAAPITOA

E ui lava o ponokalafi faʻaaogaina atonu e manatu e taliaina lautele ma masani, o le soifua maloloina lamatiaga o le masani ona le iloa. O ponokalafi i luga ole initaneti e maua ai le faʻatapulaʻaina o ni ata fou e avea ma faʻataʻitaʻiga o le Coolidge Effect, o se mea moni masani e vaaia i tama tane pe a latou faʻaalia le fiafia faʻafouina pe a faʻalauiloaina i isi feusuaʻi.24 Lenei maua ai se ono mafai evolusione aoga mafai ai se tane e faʻamalosia tele fafine. O tala fou feusuaʻiga faʻaosofia e faʻatupulaia le malosi, faʻamalosia o le faʻatupuina, ma vave faʻaosofia i le tele o gaioiga o sperm ma semen gaʻoa.25-27

Ole soona faʻaaogaina ole initaneti ponokalafi e mafai ona aʻafia ai le neuroplasticity.28 Uma vailaʻau o le sauaina ma amioga fai ma vaisu, pei o le taʻaloga Initaneti ma le soʻona taumafaina o meaʻai, e afaina ai le mesolimbic dopamine auala ma le ogatotonu.29 O mea fou e faʻalauiloaina ai le tele o le dopamine i le pito i luga, ma faʻamatuʻu ai le faʻasaʻolotoina o le cAMP tali atu aano-noataga porotini (CREB). CREB faʻatonutonuina gen gene faʻamatalaga o dynorphin, o se porotini e faʻagesegese le tatalaina o le dopamine, faʻamamaina o le taui taui.30 E talitonuina o le molimoli lea o le faʻapalepale e pei ona faʻateleina le aofaʻi o le vailaʻau poʻo amioga e manaʻomia e foia ai le tele o CREB. A ova, dopamine faʻaititia le anhedonia, ono faʻatutuina le faʻalagolago i luga o le vailaʻau poʻo amioga.

I le faʻaopopoga i le CREB, ua faʻamatuʻuina atu DeltaFosB faʻatasi ai ma le tele o dopamine lologa i le ogatotonu. DeltaFosB faʻalauiloaina lelei faʻamalosia o le vaisua amioga e ala i le taofiofia o le dynorphin tatala ma faʻateleina le faʻaitagofie i le vailaʻau poʻo amioga. O DeltaFosB e tumau pea mo se taimi umi, e taitaia nisi tagata poto faapitoa i vaisu e taʻua o le "moli moli mo vaisu."31 O lenei faiga e faʻamatalaina le faʻaaogaina soo o ponokalafi, pei o isi mea ua fai ma vaisu, mafua ai le faia o le le fiafia ma le dopamine receptor downregulation e tupu, faʻatulagaina le tagata faʻaaoga mo se taamilosaga o binging, naunau, ma le faʻaitiitia o le malosi.32

ENDOCRINE

E ese mai i le tatau ai mo le atinaʻeina ma le tuputupu aʻe o le faʻamalosi tino ma faʻamalosia feusuaiga, testosterone faʻatonutonuina erectile physiology e ala i le tele o mea. Testosterone faʻalauiloaina maloloina maloloina neura fausaga, amio saʻo, ma galuega, aemaise le tele o neura.33 Suesuega a manu ma tagata faʻapea o le testosterone faʻaleleia le nitric oxide synthase gene faʻailoa ma LEAI gaosi i penile arteries, e tatau ai mo vasodilation.34,35 Testosterone atonu e suia PDE5 gaioiga e pei ona molimauina i manu faʻaalia o faʻaalia luga-tulafono faʻataʻitaʻi o PDE5 faʻaaliga ma testosterone faʻaopopo.36,37

Laʻasaga maualalo o le maua fua ma faʻaavanoaina (ae le o le atoa) testosterone e fesoʻotaʻi ma erectile dysfunction.38 E ui o le maualuga o le testosterone e manaʻomia e ausia ma tausia faʻatuina, e le o iloa, o se laʻititi laʻititi e aliali mai e talafeagai mo le faʻavaeina.39,40 Testosterone faaopoopoga atonu e le faaleleia ED i tagata uma; ae ui i lea, o nisi suʻesuʻega ua faʻaalia ai o le testosterone togafitiga atonu e aoga ma mafai ai e le PDE-5 inhibitors ona galue lelei.41,42

O nisi tusitala na tusia maualuga tulaga estradiol i alii pe maualuga estradiol-i-testosterone fua faatatau e faatatau i ED.43-45 Aromatase inhibitors puipuia le liua o le testosterone i le estradiol ma e ono faʻateleina le aofaʻi ma le faʻaavanoaina o le testosterone i tagata matutua ma le feololo o le hypogonadism aʻo laititi ifo le maualalo o estradiol.46 Le taimi nei, e leai se faʻamaoniga o le aromatase inhibition e faʻaleleia atili ai feusuaiga ma e leai ni tusitusiga e lagolagoina ai le faʻaaogaina o le aromatase inhibitors mo le hypogonadism.47 I se faʻaopopoga, o nisi o suʻesuʻega na maua ai le fua faatatau i le va o le estradiol ma le testosterone e leai se fesoʻotaʻiga ma le faʻatuina o mea poʻo le manaʻo i feusuaiga.48,49

Ole maualuga ole prolactin secretion o se mafuaʻaga e le masani ai ole maualalo testosterone ma le ED. Lenei e mafai ona mafua i se pituitary tumor (prolactinoma), mariuana, poʻo vailaʻau e pei o amphetamines, H2 blockers, risperidone, SSRIs, MAO inhibitor, ma nisi tricyclic antidepressants. Ole Prolactin e tatau ona fuaina naʻo tulaga o le maualalo o le tuʻinanau o fafine, gynecomastia, ma / pe o le aofaʻi o le testosterone maualuga i lalo ole 4 ng / mL (400 ng / dL).50

Uma le hypothyroidism ma le hyperthyroidism e mafai ona taitai atu ai i le ED ma le ED e sili atu taatele i alii ma le dysthyroidism nai lo pule.51 Togafitiga o le hypothyroidism ma le hyperthyroidism mafai ona faaleleia ED.52 O le mea lea, suʻesuʻe mo le aʻafia tiroid i tamaloloa o loʻo tuʻuina atu ma ED fautuaina.

TUPE FAʻASOA

Lelei sili ona lelei le soifua maloloina e taua tele i le ausia ma le faʻatumauina o fausaga. Ole vevesi ole mafaufau e mafua ai le 70-80% ole le-psychogenic ED i tama matutua. Ona o le aterosklerosis o atigi korona, carotid, cerebral, po o le peripheral arteries e na o le faʻatupuina o faʻailoga pe a alualu i luma, o ED e mafai ona avea ma uluaʻi faʻailoga o le lautele o faʻamaʻi faʻamaʻi.53,54 I le Prostate Cancer ma Prevention Trial, toeitiiti 10,000 tamaloloa faʻatonutonu i le placebo lima sa iloiloina i le tolu masina ma mulimuli ane mo ED ma le cardiovascular disease mai le 1994 i le 2003. ED sa tele lava se tulaga lamatia mo le lumanaʻi o le cardiovascular events e pei o le ulaula ma aiga talafaasolopito o fatu fatu.55 Le i ai o ED mafai foi ona avea ma vavalo o uma-mafuaʻaga oti.56 E tutusa tulaga lamatia o le ED ma le cardiovascular disease - toto maualuga, leai se faamalositino, le lelei le taumafataga, ulaula, ma isuka, ma hyperlipidemia. O le faiga autu mo ED vascular-related ED aofia ai le endothelial dysfunction.57,58 O le faʻavaeina o vasodilation o se gaioiga o le nitric oxide (NO) faʻasaʻoloto e sela endothelial. LEAI amataina se gaosiga o le cGMP e mafua ai le malolo o le musele moli ma vasodilation o alatoto i le korpus cavernosum. Endothelial dysfunction faateleina ED tulaga lamatia, e tusa lava poʻo le faʻamaonia faʻamaonia o le faʻamaʻi cardiovascular.59,60

FAʻAIʻU LELEI aafiaga

E tele vailaʻau fofo e mafai ona saofaga i le ED e ala i le afaina o neurotransmitters, hormones, neura galuega, poʻo le toto tafe. E ui lava e le o se mea o faʻataʻitaʻia, o tagata taʻatele e aofia ai antidepressants (aemaise SSRI e pei o fluoxetine, sertraline, citalopram), popolega, CNS depressants, ma muscle relaxants (lorazepam, cyclobenzaprine). Diuretics (HCTZ, spironolactone, triamterene, furosemide) ma antihypertensives ma beta-blockers (clonidine, enalapril, metoprolol) e masani foi saofaga i le ED.

FILIFILIGA TOGAFITIGA

E taua le atiaʻeina o se togafiti togafiti mo ED, ona e ono sili atu le aoga nai lo le faʻaaogaina o se sooupu e naʻo faʻafitauli.

FUAFUAINA O LE PSYCHOSEXUAL

Tuʻuina atu mo le iloa o amioga, faʻafitauli ile puleaina, poʻo le pule ole faʻaipoipoga atonu e talafeagai mo nisi tamaloloa ile ED. O le mafuaʻaga fesoʻotaʻiga i le va o le atuatuvale ma le ED e le manino ma ono faifaʻalua.61 O le mea moni, tasi le faʻataʻitaʻi faʻataʻitaʻi (RCT) o tagata 152 ma faʻatasi lagona-agaʻi-feololo lagona faʻafitauli ma ED na faʻaalia le lelei o lagona i tamaloloa na tuuina atu sildenafil ina ua faaleleia a latou ED.62 O le ED e mafua mai i le popole faʻanoanoaga ma le atuatuvale e sili ona togafitia i le tagata e iai le amio o lona mafaufau, faʻafesoʻotaʻi fesoʻotaʻiga, poʻo le galulue ma se fomaʻi. E i ai foi faʻamaoniga o le faʻaaogaina o togafitiga vaega e mafai ona faʻaleleia atili erectile function. O le iloiloga a Cochrane o 11 faʻataʻitaʻi fomaʻi (iva o na faʻataʻitaʻiina), faʻaiʻu o le taulai atu i vaega o feusuaʻiga-vaega sili atu le aoga nai lo le leai se togafitiga mo ED. O le tolu-faʻataʻitaʻiga o faʻataʻitaʻiga faʻatusatusa togafitiga sildenafil sitrat ma sildenafil na o ia, na iloa ai o aliʻi na maua le faʻatalatalanoaga ma sildenafil faʻaalia alualu i luma alualu i luma o feusuaʻiga manuia ma e tele na ono maua nai lo latou na o sildenafil maua mai. Ole faʻalapotopotoga ole vaega na faʻaleleia atili le ED pe a faʻatusatusa ile sildenafil citrate naʻo ia.63

MAFAUFAUGA LOLOTO MAI POLOKALAMA FAʻAPITOA

O le toe faʻaleleia o le ED e faʻatatau i le tele o taimi o ponokalafi faʻaaogaina e manaʻomia ai le maʻi e aveese uma ponokalafi, ponokalafi sui, ponokalafi manatua, ma e taua uma o le gaosiga o feusuaiga. O lenei faʻatagaina mo le toe fausiaina o feusuaiga faʻaosofia ma le mafai ona fausia ma le moni tagata paʻaga. E ui o le taimi e toe "toe faʻaleaogaina" le faiʻai ma le aloese mai ponokalafi e le o iloa, o mea ua fai ma vaʻaiga i mea ua fai ma vaisu, Gary Wilson ua fautua mai le poto masani fomaʻi ma luga o le initaneti faʻaalia faʻaalia vave toe maua lelei mo alii i luga o 50 tausaga, fai mai o 2 masina e masani.64 E ono manaʻomia le tele o taimi mo alii talavou, pe a ma le 5 masina, ma le talitonuga o latou Initaneti e faʻaaoga ai ponokalafi amata i se tausaga matua. O feusuaiga e faʻatupu ai le ita, aemaise lava i taimi o laiti ma talavou, ma e ono malosi i tamaloloa nai lo fafine.65-67

FUA FAALELEI

Pelvic fola maso o loo faia se vaega i le tausiga o faʻatuina faavaivaia ma le matua. O togafitiga faʻamalositino e faʻamalosia ai le bulbocavernosus ma ischiocavernosus maso ma fesoʻotaʻiga o fesoʻotaʻiga e mafai ona togafitia lelei ED i nisi tagata gasegase. I se tasi faʻataʻotoʻoina, puleaina suʻesuʻega, 40 aliʻi ma ED na aʻoaʻoina ina ia faʻatetele le tele i tua o le peni ma siʻi le latou lapisi faalua i aso aʻo tu, nofo, ma taʻoto i lalo, ma faʻamalosi o latou maso fola pele ina ua uma ona aveina le urine. Iʻuga na maofa - ile 6 masina, 40% o sui auai na toe maua le malosi o le ola ma le 35% na faʻaalia nisi suiga; 66% o alii na lipotia mai foi le faaititia o le alu tete ina ua uma le urine. A faigofie auala atonu o le aʻoaʻoina o gasegase o Kegel faamalositino e ala i le taofia o latou taofi feololo i le ogatotonu e iloa ai maso o le a manaʻomia e fai le faamalositino. O nei maso e tatau ona faʻamalosia mo le 5 sekone, 10-20 taimi i le laina, tolu taimi i le aso. E mafai ona faʻamalosiʻau tamaloloa i le faia o faamalosi tino Kegel poʻo pelvic ona o le ono mafai ona faʻaleleia atili le lelei o le orgasm, o se aafiaga masani Arnold Kegel, MD tusia i le tele o tausaga talu ai i fafine na masani ona faia Kegels.68

TAIMI FAATINOINA O LE VACUUM

O le masini faʻatapulaʻa lagona faʻamalosi (VCD), masani faʻaigoaina o se "peni pamu" fuafuaina e Geddings Osbon i 1974.69 Na taʻua e Osbon o se “masini e tutusa i le autalavou” ma fai mai na ia faaaogaina ia lava ia mo le 20 tausaga e aunoa ma se toilalo. O le mea gaogao muamua faʻapipiʻi masini na taliaina FDA mo ED i le 1982.

E galue le VCD e ala i le faʻaopopoina o le toto i le penis e ala i le faʻamauina o le 110-225 mmHg le lelei o faʻamalosi (lima pe o le pamu-faʻagaioia pamu) ma taofia le alu atu i fafo i se mama. Suesuega fautua mai 55-70% o tamaloloa mafai ona ausia lava malosi ma VCDs.70, 71 Ua lipotia mai e nisi o tamaloloa le fausiaina na maua mai i le VCD e foliga mai e mama, malulu, pe mataga, ma itu aafiaga e aofia ai le afaina o le penis penisini ma le mailei o ejakata i le taimi o le orgasm mai le fusifusi vaega. Ole mama faʻapipiʻi e le tatau ona tuua i le tulaga mo le sili atu nai lo le 30 minute ona o le afaina o ischemia.

FAʻAFETAI, faamalositino, ma PULE LEAI

Le sailiga mo aphrodisiacs e faʻamalosia ai le libido ma faʻaleleia feusuaiga faʻatino aso i aso anamua. O le mea moni, o le upu aphrodisiac e sau mai le Eleni atua fafine o le alofa, Aphrodite, o le na fanau mai i le sami ma aumai i apitaogalu i se paʻu po o se atigi figota. E ui o kulimi o loʻo iai le tele o zinc e manaʻomia mo le gaosiga o le testosterone, o le 'aiina e leʻi faʻaalia e faʻaleleia atili ai le libido poʻo le faʻavaeina o malosi.

O nisi meaʻai, peitaʻi, e faʻaleleia atili le soifua maloloina ma mafai ai, ona, faʻateleina ai le malosi erectile. Mo se faʻataʻitaʻiga, o meaʻai e maualuga i le nitritate pei o paʻu ma laulaʻau lauola, e siʻitia ai le tulaga o le nitric oxide, faʻalauiloaina le masani o le endothelial function, ma le toto maualalo.72-74 Fualaʻau fatu ma le sua ua faʻaleleia atili le endothelial galuega ma faʻaititia le toto maualuga a o faʻaititia le faʻaavanoaina ma glycated LDL, faʻapea faʻaititia o atherosclerotic faʻavaeina faʻaitiitia ma faʻaititia le mafiafia pa puipui ma le faʻamalosia.75-78 Ole maualuga ole fructose corn syrup ma meainu suamalie e faʻaosoina ai le ono tupu ai ole metabolic syndrome, atherosclerosis, maʻi suka, ma ED.79 E le gata i lea, o meaʻai ma mea maualuga ua maualuga le glycation o oloa e pei o le bacon, fast food hamburgers, hot dog, cheese, pizza, ma falai meaai, saofaga i le maʻi suka, mai le fatu, ma le ED.80-82 Nai lo le taulai atu i le aloese mai mea taumafa faapitoa, atonu e sili ona aoga mo tagata ED e faʻaaogaina a Metitirani meaai ma tele taumafa o fualaʻau, fua, extra virgin olive olive, fatu atoa, nati, ma iʻa ma feololo inu uaina. O faʻamaoniga mai le fa o suʻesuʻega faʻalauiloa e faʻailoa mai ai o le meaʻai a le Metitirani ma le olaga, e aʻafia ai feusuaiga83,84 faʻapea foi le tuʻu i lalo o le fulafula ma faʻatuai le feusuaiga i tamaʻi maʻi.

E i ai laʻitiiti fefaʻatauaʻiga o gaioiga o loʻo faʻaleleia atili ai le tele o mea faʻaletonu e fesoasoani i le ED e aofia ai le faʻaitiitia o le feʻaveaʻi, faʻaleleia atili o le endothelial function, faʻalauiloaina le inisalini, alualu i luma lipoproteins, ma faʻalauteleina le gaʻo paʻu.85-89 O se lata mai nei suʻesuʻega masani ma faʻamaumauga meta-faʻamaonia e faʻamaonia ai o le malosi-o-malosi-malosi malosi faamalositino mo le itiiti ifo o le 8 vaiaso mafai ona faaleleia ED.90

O meaʻai e tele naʻo le le lava o le tino e fesoʻotaʻi ma ED. Mo se faʻataʻitaʻiga, o le Hallym Aging Suesuega fuaina tino gaʻo pasene ma lona fesoʻotaʻiga ma ED i Korea Korea.91 O alii e maulalo ma pito sili ona maualuga le gaʻo o tino na sili atu ona ono maua i le ED. Ole ogatotonu ole maʻemaʻe e fesoʻotaʻi ma le metabolic syndrome, o le vascular dysfunction, ma le maualalo o le testosterone, o ia mea uma e fesoasoani i le atinaʻega o le ED.92,93 O gaʻo e gaosia ai le sili atu ma le 35 hormones ma cytokines, e toetoe lava o mea uma e faʻatupuina ai le afaina, teteʻe atu i le inisalini, ma mulimuli ane, faʻamaʻi o le vaskular.94,95 Inflammation foliga mai o se tagata taua i le mafuaʻaga ole ED. O tamaʻi lapopoʻa ma le ED e maualuga atu le maualuga o faʻamaʻi taua (IL-6, IL-9, IL-18, ma CRP) ma le afaina ai le gaioiga endothelial nai lo tagata lapoʻa leai se ED.96

O le leiloa o le mamafa mafai ona sili atu faaleleia erectile galuega. I le tasi RCT, o maʻi tino na leiloa le aofaʻiga o le 33 pauna i luga atu o le 2 tausaga na faʻaleleia atili le faʻataʻitaʻiga o gaioiga.97 Na faʻaleleia e le ED le sili atu i le 30% o le paʻu paʻu faʻatusatusa i le 5% o pulega. Na maua e le vaega fesoasoani le fautuaina o meaʻai paleni, fautuaga ia faateleina le tino i le 3 itula i le vaiaso, ma masina taʻitasi poʻo le taʻi lua masina. I le faʻaopopoga o le mamafa o le 15%, na faʻaalia foi e tamaloloa i le vaega o faʻaletonu le faʻaitiitia o le faʻaititia o maʻi IL-6 ma le hsCRP, ma faʻaleleia atili ai a latou cardiometabolic.

BOTANICALS MA AMINO ACids

Le faʻaaogaina o botani, meaʻai, ma isi togafitiga faalenatura e faʻaleleia atili ai le feusuaʻiga ua faʻateleina faateleina ona o le Initaneti maketiina. Na o ni nai togafitiga masani na faia faʻataʻitaʻiina tagata e lagolago le saogalemu ma le aoga. Ae ui i lea, o mea nei o botanicals ma amino acids e ono fesoasoani i le togafitia o le ED, aemaise lava mo tamaloloa e mananaʻo e le faʻaaogaina vailaʻau PDE5i.

Faʻafiafia le lalolagi

O Yohimbe o se tamaʻi lanumeamata e tau i Aferika tutotonu e aofia ai le tolu alkaloids: rauwolscine, corynanthine, ma yohimbine. Le vaega sili ona malosi o le yohimbe, yohimbine, o se vailaau faʻatasi ai ma se lelei faʻataʻotoina o gaioiga o gaioiga e pei o se teteʻe i le presynaptic α1 ma le a2-Arrenergic ma 5-HT (1B) talipupuni ma se vaega agonist o 5-HT (1A).98 Meta-auiliiliga fautua mai o yohimbine e aoga mo ED99,100 E mafai foi e Yohimbine ona fesoasoani i le tuai ona gafatia pe le mafai ona toe malosi.101 Totoga o le 15–30 mg, oʻo i le 100 mg i le aso. Atonu e sili ona momoli Yohimbe i luga ole manaʻoga talu mai le amataga, e vave, i totonu ole 10-15 minute, faatasi ai ma le 35-minute afa-ola. Yohimbine ati le totonugalemu o le tino ma ni itu itu e ono aofia ai tachycardia, toto maualuga, ita, ma le popole. Afu, mageso, niniva, uluulu, ma paʻu paʻu ua masani foi. E pei o mea uma botanicals, tele sili-o-le-faʻapipiʻi faʻailoga ono ono le talitonuina. Tasi lea suʻesuʻega 49 ituaiga yohimbe na maua le tele o fesuiaʻiga i le aofai o yohimbine - 0 i le 12.1 mg - i le tautua ma 19 ituaiga e leai se rauwolscine ma corynanthine.102

Tulimanu

T. - terrestris tuputupu ae i Europa, Asia, Aferika, ma Sasaʻe tutotonu. O le aʻa ma fualaau 'aina e umi ona faʻaaogaina i vailaʻau Saina ma Ayurvedic. E masani ona fai mai o le Tribulus e faʻaleleia atili ai le gaosiga o le testosterone; ae ui i lea, e leʻi lagolagoina e lenei faʻamasinoga suʻesuʻega nei seʻi vagana le faʻaaogaina intrates i le primates.103-106 Suesuega a manu ua faʻaalia ai Tribulus mafai ona faʻaleleia atili erectile galuega ma LEAI gaosi.107,108 Tasi RCT o 180 tamaloloa ma le agavaivai-agai-feololo ED faʻaaogaina 500 mg o faʻavasegaina T. - terrestris ave faʻatolu taimi i aso uma lipotia le faʻaleleia o le libido, ED, faʻafeiloaʻiga faamalieina, ma le lelei o le orgasm. Leai ni mea leaga na lipotia.109

Eurycoma longifolia

Eurycoma longifolia, lauiloa le Malaysian ginseng poʻo Tongkat Ali, o se laʻau fugalaʻau e ola mai i Indonesia, Meleisia, Thailand, Vietnam, Laos, ma Initia. Ua fai mai se au-auiliiliga o RCT E. longifolia matua faaleleia le ED.110 E le gata i lea, o se Saina toe iloilo lolomiina suʻesuʻega ua taʻu mai E. longifolia faʻaleleia le seleni, libido, ma le testosterone.111 Atonu e iai se agavaʻa faʻatonutonuina ole laʻau, ma ua faʻaalia e faʻaititia ai le lelava, faʻalelei le soifua maloloina, maulalo ai le cortisol, ma faʻateleina testosterone i mataupu popole.112 Aveina o se vai puna aa, Eurycoma foliga saogalemu e aunoa ma taua itu afaina. Ole fua faatatau fautuaina ole 200-300 mg tasi pe faalua i aso uma, faatasi ai ma se pateni pepa ua faalaugatasia i le 22% eurypeptides ma le 40% glycosaponins.

Epimedium spp.

Epimedium spp. tupu i Saina ma Korea, ma auai i le aiga Berberidaceae (lea e aofia ai ma le lauiloa botanicals, Mahonia aquifolium, Hydrastis canadensis, ma Berberis vulgaris). Le itiiti ifo i le 50 ituaiga ua faailoaina ma ua masani ona taua o "horny 'oti vao". O le vaega fuafuaina, icariin, o se flavonoid e faʻaleleia atili ai le faʻatuina i gaioiga manu i suʻesuʻega e ala i le PDE5 taofiofia ma nitric oxide.113-115 - Tagata soifua suʻega tofotofoga Epimedium ua leai; o lea, fautuaga dosis e le o avanoa.

L-arginine

L-arginine o se amino acid, taua i tulaga ma le maualuga o le arginase enzyme, pei o le maʻi suka ma fatugaʻo toilalo.116,117 Arginine o loʻo faʻaaogaina e enterocytes usus ma hepatocytes ma liua i le L-citrulline poʻo le L-ornithine. O suiga i le faʻaaogaina o le oral L-arginine e taua tele - o le 6 g vailaʻau e tusa 68% faʻaaogaina ae o le 10 g fua na o le 20% faʻaaogaina.118,119

Nitric oxide o le sili atu oloa o L-arginine liua i citrulline. I se faʻaopopoga, o le faʻapipiʻiina o le citrulline e faʻateleina ai le plasma arginine. Arginine mafai ona faaleleia ED i maualuga maualuga; mo se faʻataʻitaʻiga, 5000 mg faʻaleleia le ED, aemaise pe a fai o le urinary NO metabolites e maualalo.120 I le tulaga faʻataʻitaʻi, L-arginine e ono sili ona aoga peʻa fai le maualuga o ADMA. Talu ai ADMA e taofia le eNOS, o le endothelial enzyme e manaʻomia mo le LEAI gaosi, L-arginine faaopoopoga e mafai ona toe faatuina le arginine-to-ADMA fua faatatau.121 L-arginine faaopoopoga atonu e sili atu aoga mo ED pe a faʻatasia ma yohimbine po o pycnogenol (pine paʻu o Pinus pinaster).122-124 Faʻaopoopoga ma L-arginine mafai faʻagaioia herpes ma faʻateleina mala. I se faʻaopopoga, o le RCT lomia i le 2013 lipotia 3000 mg o L-arginine aveina 3 taimi i le aso ma faʻateleina ai le tulaga lamatia i tagata mamaʻi lata mai o le MI.125

FUA faʻaaoga vailaʻau

O faʻataʻitaʻiga masani a le pharmacological mo ED o le PDE5 inhibitor, apomorphine, ma intracavernosal tui togafitiga.

Initaneti PDE5

Phosphodiesterase ituaiga 5 inhibitor (PDE5i) o le sili atu ona masani vailaʻau togafitiga mo ED. O la latou faiga o gaioiga ua lauiloa, o loʻo taofia ai le phosphodiesterase type 5 enzyme lea e malepe ai le cGMP, ma umi ai le faaumiumiina o LE gaioiga i penile arteries. Vailaau o lenei vasega eseʻese a latou filifiliga mo le 11 eseʻese PDE isoenzymes. O lenei satauro-reactivity ma PDE isoenzymes e masani lava ona maua i vascular, visceral, ma pulmonary smooth muscle ma saofagā i aafiaga itu.126 Mo se faʻataʻitaʻiga, o le vardenafil ma le sildenafil e tolu ma fitu taimi e ono fusifusia i le PDE6, o se enzyme i le retina e fesiuaʻi le malamalama i neura. Inhibhibisi o lenei enzyme mafua ai lanu malamalama lagona faʻalavelave lauiloa o "chromatopsia."

E fa PDE5i fualaau ua faamaonia FDA - sildenafil i 1998, vardenafil ma tadalafil i 2003, ma avanafil i 2012. Leai se ulu-i-ulu faʻataʻitaʻiga faʻatusatusa le aoga i nei vailaʻau. O nei vailaʻau e eseese i le amataga, umi o gaioiga, ma aʻafiaga.127 Ole amataga ole sildenafil ma le vardenafil o le 30-60 minute ile umi ole 10-12 itula. Ole amataga ole Tadalafil e 15-30 minute e fuafua lava ile fua, ae umi ole umi ole 36 itula. O le Avanafil e sili ona puupuu le amataga, i totonu ole 15 minute, ma le umi, e tusa ma 6 itula.

Ole faʻaaogaina ole PDE5i e ono faʻaititia ai le kanesa o le prostate, masalo ona o tamaloloa e faʻaogaina i latou e ono soʻona faʻamalosi soo, e puipuia ai mai le kanesa ole prostate.128,129 Taimi umi sildenafil citrate (Viagra) faʻaaogaina e fesoʻotaʻi ma le siisii ​​faʻateleina lamatiaga mo le melanoma.130 Sili ona masani aafiaga itu o PDE5i aofia ulu tiga i luga o 20% o alii, fufuluina i 15%, ma dispepsia ma nasal congestion e oo i le 10%. E ui e le masani ai, niniva ma priapism mafai ona tupu. Uma le PDE5i o loo taofia ai i tane aveina nitrates.

Apomorphine

O le Apomorphine ua leva ona faʻaaogaina talu mai le 1869 mo le Parkinson, ma ua maeʻa suʻesuʻeina mo ona aʻafiaga i le faʻatuina o le tino. E ui lava e maua mai le morphine, o le apomorphine e le oi ai le morphine pe fusifusia i le opioid receptors. E i ai le maualuga fesoʻotaʻiga mo dopamine talini ma le auala mo le faʻaleleia atili o feusuaiga ma faʻatuina e ono ala i le feololo le vavalalata mo D2 tagata talia i le hypothalamus ma le limbic system.131 I vaega o le tagata II ma le III faʻataʻitaʻiga tofotofoga aofia ai 5000 tagata, 3-4 mg o sublingual apomorphine maua ai malosi malosi mo le tui i totonu o 10-25 minute, ma pe a ma le 20-25% faʻaleleia o le placebo.132,133 Naʻo le pau o le vailaau oona o le apomorphine i le US o le Iniseti Apokyn, o le FDA ua faamaonia mo le siʻitia o le maʻi Parkinson; ae ui i lea, apomorphine e mafai ona faʻatasia e pei o se sublingual lozenge ma mafai faʻatasia ma se PDE5i. O meaʻai o le 2–3 mg e ono aoga e pei o le 4-6 mg e aunoa ma aʻafiaga e pei o masi, tiga le ulu, pe niniva. E le tatau ona faʻaaogaina le Apomorphine ma le ondansetron hydrochloride, o se mea e masani ai ona puipuia, ona o le ono teteʻe.

Intracavernosal tui

Faʻailoaina i le 1983, intracavernosal injections teuteu le endothelial galuega ma e aoga tele tusa lava i tamaloloa ma ogaoga ED; o alprostadil e tupu ai faʻatufuga i luga atu o 93% o tamaloloa, ma le lelei o le faʻa, tri-, ma quad-mix e oʻo i le 97.6%.134-136 Alprostadil, 20 po o le 40 μg o prostaglandin E1, na o le pau o le iniseti introsalvernosal tui ua faamaonia FDA, ae e lua isi vailaʻau, phentolamine ma papaverine, e mafai ona faʻaopopoina i le PGE1 i se faʻavae fofo. Ole aafiaga pito sili ona taatele o PGE1 naʻo le tiga ile 48.5% o tamaloloa. Ole bi-mix, o loʻo masani ona iai le 0.5-3.0 mg phentolamine ma le 30 mg papaverine, e le mafua ai le tiga ae atonu e le aoga. Tri-mix, e masani ona i ai i le 5-10 μg (ma e oʻo atu i le 40 μg) o le PGE1, 0.5-1.0 mg phentolamine, ma le 15-30 mg papaverine, e faʻaititia ai le tiga i le 2.9%. O le faʻaopopoga o le 0.15 mg atropine i le quad-mix, faʻapitoa mo tamaloloa e le lelei le faʻafefiloi o le tri-mix, sili atu le faʻaititia o tiga. Ole tau ole PGE1, bi-, tri-, poo le quad-mix e manaʻomia mai le 0.1 i le 0.3 mL. Empiric (faʻaaogaina le PGE1 na o se mea e faʻatatau i le ED etiology poʻo le faigata, ma le fua poʻo le fesuiaiga o tulafono na faia e faʻavae i luga o le faʻamama iʻuga) ma faʻaletonu-faʻavae (faʻaaogaina bi-mix, tri-mix, poʻo le maualuga-dos tri-mix faʻavae i luga o se algorithm factoring ED etiology ma numera o ED tulaga lamatia itu) faʻaaliga i tui foliga foliga tutusa lelei e uiga i le lelei ma le faʻapopoleina ma le faamalieina fua faatatau.137 O aʻafiaga e aofia ai le tiga ile nofoaga tui, priapism, ma le faʻavaeina ole ila ile tino poʻo le maʻi ole Peyronie. Mo se tala sili ona lelei iloiloina iloiloga lelei, tui, ma aafiaga itu o tui intracavernosal, vaʻai le aotelega Medscape "Intracavernosal Injection Algorithm" saunia e Jeffrey Albaugh.138

LOW-INTENSITY EXTRACORPOREAL SHOCKWAVE FUA

Luga le maualalo extracorporeal shockwave (LI-ESW) na mafua mai i 1990s ina ua faʻaalia le ultrasound na mafua ai angiogenesis i manuʻa isumu.139 LI-ESW faʻaaogaina galu teteʻe, o se ituaiga o tisiki galu o loʻo feʻaveaʻi le malosi ma faʻaosofia gaioiga faʻanatura pe a faʻatatau i le lapisi tisu.140 O le tau e fesuisuiai i tuutuuga o malosi malosi flux, taimi masani (numera o pulses i le sekone i Hz), ma le aofaʻi numera o pulses tuuina. O le faiga o gaioiga mo le faʻaleleia atili o le ED foliga mai o le toe faʻafouina o le penonal neuronal nitric oxide (nNOS) o neura lelei, faʻaleleia atili o le nitric oxide, ma le endothelial ma vascular smooth muscle musele seleni e ala i le faʻauuina o le mesenchymal stem sela.141 Ole togafitiga e mafai ai foi ona faʻafaigofieina lotoifale penile progenitor sela.142 Le taimi nei, LI-ESW e leʻo FDA-faʻamaonia mo ED; ae ui i lea, e tele faʻataʻitaʻiga faʻataʻitaʻiga na faia ma le saogalemu saogalemu ma eseese le manuia.

O le muamua ED pailate suʻesuʻega lomia i le 2010 na faʻaogaina ono LI-ESW sauniga i 20 tamaloloa e le o ni tali i le PDE5 inhibitor (PDE5i). Iʻuga na faʻaalia ai le faʻaleleia atili o le faʻavaeina, o le umi o le faʻatuina, ma le malosi o le penile i le 1 masina. E alualu i luma lipoti mo le 6 masina o le toe siaki.143 E tele RCT ua lipotia mai ni taunuuga lelei e faaaoga ai le LI-ESW. I se tasi faamasinoga na aofia ai 67 tamaloloa ma ED na tali atu i le PDE5i, o le lima togafitiga na mauaina 12 sauniga ma le lelei o le fausiaina o le malosi ma le penody hemodynamics vaaia i le 50% o alii e aunoa ma le faʻaaogaina o la latou PDE5i.144 I se tali tutusa RCT i Initia e aofia ai 135 PDE5i tali na togafitia ma 12 vasega, 78% o tagata na togafitia na mafai ona ausia le malosi o le malosi mo le tui e aunoa ma vailaʻau i le 1 masina.145 E ui lava o nei iʻuga na lagolagoina i le 1 tausaga o toe faʻaauau, sa i ai le maualuga maualuga tuʻuaiga e aofia ai 58% o le pepelo ma 42% o lima togafitiga.

O tamaloloa e le tali atu ile PDE5i atonu e avea ma tagata tali atu pe a maeʻa le togafitiga a le LI-ESW. I se tatala-tusi, tasi-lima suʻesuʻega suʻesuʻega o 29 aliʻi le tali atu i PDE5i, 12 togafitiga mafua ai 72% o tagata mafai ona ausia malosi malosi lava mo le ulufale atu i se PDE5i.146 I se RCT e sili atu lata mai e aofia ai 58 PDE5i e leʻi tali mai, 54% na tali atu i le PDE5i pe a uma le 1 masina o le LI-ESW togafitiga pe a faʻatusatusa i le 0% i le kulupu.147

Lagolagoina le alualu i luma vaaia i suʻesuʻega mulimuli na fautua mai e faapea pe a uma togafitiga, o nisi tagata e mafai ona toe suia ai lalo o faʻafitauli mafua ai latou ED po o le LI-ESW mafai ona maua ai se tikeri o le penile toe faaleleia. I le tasi RCT ma le 6 masina tulitatao o le 112 tane, o latou uma na mauaina le lima togafitiga togafitiga talu le placebo lima na maua togafitiga malosi i le 10 vaiaso, i le 6 masina, pe tusa o le 20% o le togafitiga muamua ma le 23% o le na togafitia muamua sa mafai lava ona faia feusuaʻiga vaega a le placebo vaega e aunoa ma vailaau.148 O le isi 1 tausaga o le toe siakiina o le 50 tagata matutua (averesi tausaga 65 tausaga) ma mea e ono aafia ai e aofia ai i le maʻi suka, maualuga o le toto, dyslipidemia, ma atigi koronary artery maua se 60% alualu i luma i le ogaoga ED ma le tagata lava lipotia tulaga o le fausiaina.149

Ole numera o togafitiga LI-ESW mo lelei le taunuʻuga ma le umi le aoga o le togafitiga e le o iloa. O le RCT talu ai nei na faia i luga o tamaloloa 126 i le Falemaʻi Tenimaka faatusatusaina tamaloloa na maua le lima i le sefulu sauniga i le 6 ma le 12 masina; togafitiga e tusa ma le 38% lelei i vaega uma e lua, ma faʻapea mai e le mafai ona faʻaleleia atili le faʻaalu o sauniga.150,151 I le 2 tausaga tulitatao o se tatala-faʻamau faʻamasinoga o tagata 156, 63% faʻaleleia i le 4 vaiaso ma le 53% o loʻo lagolagoina le 2 tausaga.152 Le mea e te faʻateʻi ai, o aliʻi ma le ogaoga ED na i ai muamua le toilalo. O gasegase uma i le maʻisuka ma ogaoga ED na leiloa le aʻafiaga, ae 76% o tamaloloa ma le ED maualalo pe a aunoa ma le maʻi suka na puipuia lelei le aoga.

Ole numera o suʻesuʻega e faʻaaogaina LI-ESWT mo ED ua faʻaopoopoina tele i tausaga talu ai nei. O le tala o le iloiloga faʻasalalau o tusitusiga faʻalauiloaina faia i le 2013 lipotia o 60-75% o PDE5i tali mafai ona ausia ereksi mautu lava mo le tui e aunoa ma vailaʻau ma 72% o PDE5i lē tali mai avea ma tali.153 O lata mai meta-auiliiliga na iloiloina 14 suʻesuʻega e aofia ai ma 7 RCT na iloa ai o le LI-ESW togafitiga e saogalemu ma lelei, ma taunuuga e tumau i le 3 masina.154 O aliʻi e vaivai pe le lelei ED foliga mai e sili atu le tali atu nai lo alii o ogaoga ED, ma malosi malosi flux, numera o galu galu tuuina atu, ma le umi o togafitiga e fesoʻotaʻi vavalalata ma iʻuga.

PRP MA FUAI SULU tui

Le tui o platelet mauoa plasma (PRP) poʻo selini vaega o le mesenchymal i totonu o le corpus cavernosum o loʻo taofia folafolaga e faʻaleleia atili le ED ma toe faʻaleleia le alatoto o le penile ma le neura. Mo le saunia o le PRP, o le platelet mai le anti-coagulated toto o loʻo viliina i le centrifuge ma faʻaputu. PRP o loʻo aofia ai le sili atu nai lo le 300 bioactive protein, tuputupu ae mea, ma le faʻamalosia o moli e mafai ona faʻaleleia le faʻamaloloina o le 'ie ma faʻalauiloaina le neura ma le vascular tissue regeneration.155-157 Talu ai o le penas vasculature o le pito sili ona mauoa i le itulagi o le tino o le tagata ma o le toto tafe i le flaccid penis e telegese faʻatusa faʻatusatusa i le faʻatautaia o loʻo i ai (faʻataga mo le sili atu le taofiofia), i le manatu, PRP mafai ona maua ni penefiti i le penile tisu tutusa ma le faʻaleleia vaʻaia i manuaga orthopedic .

Faʻasalalau le saogalemu ma faʻamoemoe faʻataʻitaʻiga suʻesuʻega faʻaaogaina PRP mo ED ua faʻasalalauina. Tasi tagata faʻataʻitaʻi na faia i Italia iloilo 9 aliʻi ma le ED na mauaina le PRP e faʻaopopo i le masini vaʻavaʻaia. O le agamalu alualu i luma na vaaia i le pau lava o le aafiaga leaga o le tiga tiga ma maʻimau i le nofoaga o tui.158

Ua faʻaititia le maualuga o le faʻasalalauga o sela endothelial progenitor (EPCs), o se ituaiga o stem cell e manaʻomia mo le toe faʻafouina o le vascular endothelial lining, o se tutoʻatasi tulaga lamatia mo ED.159 E faʻaititia le EPC i le maʻi masani ona vaaia ile maʻi suka, sili atu ile kolose, maʻi suka, maʻi ole fatu, ma ulaula tapaa.160 Suesuega a manu faʻaalia o testosterone faʻatupuina le EPC faʻamalosia mai le ivi ma faʻaleleia le angiogenesis.161,162 Lua iloiloga o faʻasalalauga manu faʻasalalau e aofia ai tui intracavernosal o tupuga sela maua mai i ponaivi ponaivi, adipose tisu, ma le skeletal maso lipotia taunuuga lelei i luga o le endothelial, musele lamolemole, ma neura galuega i le penile tisu.163,164

Fesoasoani a le PRP ma le stem cell e mafai ona fesoasoani i tamaloloa i manuʻa o le vascular ma neura mai le maʻi suka poʻo le prostate. O ni nai tagata pailate suʻesuʻega fautua mai o le taualumaga atonu e saogalemu ma lelei. O le tasi suʻesuʻega na aʻafia ai 11 tamaloloa na uia le puipuiga o le prostate ona o le kanesa o le prostate, ma maua ai le ED e le tali atu i le PDE5i.165 Autologous adipose-maua mai sela stem tui i totonu o le corpus cavernosum toe maua erectile galuega i le valu o le sefulutasi alii e aunoa ma aafiaga leaga. I se isi pailate suʻesuʻega o loʻo faʻaaoga ai sela o le umbilical tagata e le o ni autologia, ono i le fitu tagata matutua ma le maʻisuka ma ED e le tali atu i le PDE5i, na toe oso i le taeao i le masina lona tolu, ma e lua mai le fitu na mafai lava ona maua se faʻatuina ma le PDE5i pe a uma le 6 masina. O le mea e malie ai, o le toto i le toto na faaitiitia i le 2 vaiaso ina ua maeʻa tui, i le hemoglobin A1C maualuga na oʻo i le 4 masina, ma e leai ni aʻafiaga leaga na vaaia. O faʻaiuga lelei na vaʻaia foi i se tagata pailate suʻesuʻega e aofia ai 12 tamaloloa ma le ogaoga o le prostatectomy ED e le tali atu i le alprostadil, PDE5i, poʻo le masini vaʻa.166 Ole vaega lea ole faamasinoga na ou faʻaogaina ai le faʻateleina o tui o autologous bone marrow-maua mai sela stem. O tui maualuluga na sili atu le aoga i le iva mai le sefulutasi tamaloloa na mafai ona ausia le malosi o le faʻamalosi mo le tui i le PDE5i; penefiti na faʻatumauina i le tasi tausaga e aunoa ma ni aʻafiaga leaga.

E ui lava e manatu faʻataʻitaʻi ma le tui sela a le PRP ma le leai o se faʻamaoniga a le FDA ma inisiua, e ono sailia e aliʻi fomaʻi o loʻo faia nei faʻatinoga. O aʻafiaga leaga e ono aofia ai le faʻamaʻi pipisi ma le atinaʻeina o se maʻila poʻo le maʻi o Peyronie. I le tulaga faʻavae, stem cell e ono faʻaopopo foʻi le tumorigenesis, e ui lava o le lautele o lenei lamatiaga e le o iloa.167

FAAIUGA

Erectile afaina o se masani masani faʻafitauli ma faʻafitauli tele, tele i luga o mea taua mafuaʻaga. Faʻaeteete ma totoʻa tala faʻatulagaina, faʻaaogaina o suʻesuʻega faʻamaoniaina, suʻega faʻaletino, ma galuega faʻataʻitaʻi e taua e manaʻomia e atiaʻe se fuafuaga e faʻaleleia atili ai faʻailoga a o feagai ma mafuaʻaga. Togafitiga filifiliga e aofia ai le meaʻai ma auala e suia ai le tino, faʻamalositino faamalositino faamalositino, le faʻaaogaina o le gaogao masini faʻatapulaʻa, mea taumafa ma ni vailaʻau tui, vailaʻau, maualalo malosi extracorporeal shockwave togafitiga, ma atonu platelet mauoa plasma po o sela intracavernosal tui.

AʻOAʻOGA MO LE FAIGA FAʻAPITOA
  • Faia lelei tala faʻasolopito, pepa fesili, suʻega, galuega talafeagai
  • Talanoaina mafuaʻaga / sao taua:
    • Tomaʻi
    • Neurological
    • Faʻateleina ponokalafi faʻaaoga
    • Endocrine
    • Vailaau itu aafiaga
    • Suiga vascular
  • Iloilo filifiliga talafeagai togafitiga:
    • Fautuaina mafaufau
    • Ponokalafi ponafita
    • Faʻamalositino togafitiga (Kegel's) poʻo le faʻaaogaina o le gaogao masini faʻaititia
    • Suʻesuʻega o meaʻai
    • Faamalositino fautuaga
    • Malosiaga leiloa filifiliga
    • Fofo vailaʻau ma amino acids
    • Vailaʻau:
      • PDE5i: eseese onsets, umi o gaioiga, ma itu-afaina
        • E mafai pe le mafai ona ufiufi e inisiua, e mafai ona taugata
        • Apomorphine, ae le o le FDA-faʻamaonia mo ED, e tatau ona faʻapipiʻi
    • Laititi-malosi extracorporeal shockwave
    • E le taliaina FDA mo ED ma le leai o inisiua inisiua
    • O loʻo lelei le faʻamaumauga e faʻamautu ile tele o suʻesuʻega
    • Atonu manaʻomia toe togafitiga
  • PRP ma le stem cell tui
    • E le fautuaina ona o le le lava o faʻataʻitaʻiga ma faʻafitauli i le saogalemu
SAUNIGA FAʻAFETAI

Fai mai le tusitala, e leai ni ana tauvaga.

FAʻAFETAI MA TUPE

E leai se tupe na mauaina mo le tapenaina ma le tusia o lenei tusitusiga.

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FAIA: https://doi.org/10.14200/jrm.2019.0104

Manatua: o le seti fa'amaumauga o lo'o fa'atatau i le numera 6 o le https://bedbible.com/sex-frequency-statistics/.