Tsamaiso ea Erectile Dysfunction Management bakeng sa Bokamoso
Tlaleho ea Andrology, Moq. 30, che. 4, Phupu / Phato 2009
Tokelo ea molao © American Society of Andrology
DOI: 10.2164 / jandrol.108.006106
ARTHUR L. BURNETT
Ho tsoa Lefapheng la Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
inahaneloang Ts'ebetso ea taolo ea erectile dysfunction (ED) ha nako e ntse e feta e bone bopaki ba ho kenella ka morero ho thusa banna ho etsa thobalano. Morao tjena, tsoelo-pele e kholo lipatlisisong tsa ED e lebisitse ho kalafo e sebetsang e sebetsang e thehiloeng tsebong e ntlafalitsoeng ea motheo oa mahlale oa penile erection. Likhopolo tsa hajoale li fana ka maikutlo a hore menyetla ea kalafo e tlang kapele e kenyelletsa litlhare tsa litlatse, mofuta oa kalafo ea kholo ea kalafo, kalafo ea liphatsa tsa lefutso, le phekolo ea bocha. Morero oa tlhahlobo ena ke ho hlahisa metheo ea kalafo ea moso ho tsamaiso ea ED.
Tsamaiso ea Erectile dysfunction (ED) e hatetse pele haholo lilemong tse fetileng tsa 25 ka kenyelletso ea likhetho tse ngata tse makatsang tsa kalafo. Haufinyane haholo, taolo ea ED e ne e lebisitsoe haholo litekanyetsong tsa kelello kapa tsa li-hormone, ho latela monahano oa hore tsena e ne e le maemo a bakoang ke pherekano ena. Ka hona, kalafo e ne e sebelisoa hangata ka mekhoa ea psychoanalysis, kalafo ea thobalano le ho kenella hoa lihomone. Haeba taolo e joalo e sa sebetse, ho sebelisitsoe maano a mang ho qala ka litlama tse entsoeng ka litlama ho khothaletsa ts'ebetso ea thobalano ho lisebelisoa tsa mochini. Bakeng sa morao-rao, matlapa a pele a penile a 1950 le theknoloji ea vacuum-pump ea li-1960 tsa morao-rao li ile tsa tiisoa hore li theha ramatiki ea penile, e tlosa tlhokahalo ea tsebo e felletseng kapa ts'ebeliso ea physiology kapa thepa ea biochemical ea karabelo ea erectile.
Morao tjena, tsoelo-pele ea saense lithutong tsa mmele le molek'hule ea penile erection li hlahisitse phekolo e ncha ea ED. Mehleng ea 1970 ea pele, mokhoa o bohlale e ne e le tlhaloso ea phetisetso ea penile, e etselitsoeng ho khutlisa ts'ebetso ea phallo ea mali le motheo oa ho kenya mali penis. Ho ile ha fumaneha hore liopereishene tsena li ne li tla emela karolo e lekanyelitsoeng feela ea mokokotlo oa kalafo bakeng sa ED, ba sebeletsa sehlopha se tšesaane sa banna ba nang le ED se amanang le ho phatloha habohloko ha methapo e meholo ea pudendal e fang mali botoneng.
Kamora nako, tsoelo-pele e kholo e ile ea fumaneha ka har'a mefuta ea kalafo ea litlhare - kalafo e neng e thehiloe kutloisisong ea kutloisiso ea khemistri e amanang le thipa ea litho tsa botona le botšehali kahare ho botoneng. Ka tatellano, tsena e ne e le intracavernosal pharmacotherapy e ileng ea hlahisoa ho li-1980 tsa pele, intraurethral pharmacotherapy e ileng ea hlahisoa bohareng ba 1990s, le pharmacotherapy ea molomo e hlahisitsoeng ho elella bofelong ba li-1990s - kaofela li bontšitsoe ka lipatlisiso tsa motheo tsa saense le tleliniki ho emela likhetho tse sebetsang, tse sebetsang tsa ho laola ED.
Hammoho le phetoho ena ea kalafo ea ED, ho ile ha tla mekhoa e mecha ea ho nahana ka ho lekola le ho abela bakuli kalafo. Ntho ea pele e ileng ea tla ke tlhaloso ea bothata ka nepo le ka mokhoa o hlakileng joalo ka "ho sitoa ho fihlela le ho boloka litlhahiso tsa boleng bo lekaneng ho lumella thobalano e khotsofatsang" (Mekhatlo ea Naha ea Bophelo, 1992). Ntle le moo, ho ile ha amoheloa hore ED e nkile karolo e ikhethileng 'me ka nepo e kenyelletsa mokuli le molekane molemong oa ho tseba, ho lekola le ho qala kalafo e nepahetseng. Tumellanong le mokhoa ona o mocha oa litloaelo tsa bongaka, ho ile ha khothalletsoa litlhare tse seng kae tse hlaselang le tse ka khutlisoang. Mokhatlo ona o boetse oa fana ka maikutlo a hore monyetla o eketsehang oa bakuli ho etsa liqeto mabapi le taolo ea bona ea ED. Meriana ea molomo, joalo ka li-inhibitors tsa molomo tsa phosphodiesterase (PDE5), e tsejoa e le kalafo ea mohala oa pele; Lisebelisoa tsa vacuum le liente tsa penile li emela kalafo ea mohala oa bobeli; 'me ho buuoa ka penile prosthesis ho khethoa e le kalafo ea mohala oa boraro.
Ho kenella hona joale bakeng sa ED ke litlamorao tsa tsoelo-pele e kholo tšimong ea bongaka ba thobalano. Mekhoa ea phekolo e mecha e bonts'a phetoho ea saense ea cellular le ea limolek'hule ea phallo ea mmele oa batho ba tsoileng matsoho. Mekhatlo ea Epidemiologic ea maloetse a nang le lefu la methapo ea methapo, le methapo ea kutlo, le endocrinology le tsona li thusitse ho nchafatsa monahano ka mekhoa ea ts'ebetso ea pathophysiologic e ikarabellang ho ED. Ha joale ho amoheloa hore lintlha tsa kotsi ho ED li kenyelletsa ho eketseha ha lilemo, mafu a pelo, lefu la tsoekere, maemo a kotsi a tikoloho a kang ho tsuba koae le lintlha tsa bophelo tse kang ho se ikoetlise. Ntle ho pelaelo, ts'ebetso e kopaneng ea bo-ramahlale e kenyelletsang litsebi ho tsoa lithutong tse fapaneng tsa biomedical e matlafalitse kutloisiso e ncha ea saense mme e hlahisitse maano a lebisitseng taolong e sebetsang ea ED ho banna ba bangata lefatšeng ka bophara.
Nakong ena e mahlonoko tšimong, haholo-holo ka ho fumaneha ha kalafo e sebetsang ea molomo bakeng sa ED, ho hlaha potso ea hore na re hlile re fihletse "kalafo e loketseng". Ebile, leha linyehelo tsa hajoale li tsamaisoa habonolo, li thehiloe ho tsa mahlale, hape li netefalitsoe hore li sebetsa ho feta tsa nakong e fetileng, li ntse li na le mefokolo. Tsena li kenyelletsa tlhokomeliso ea hore ha e sebetse kamehla kapa e bonolo ho e sebelisa ebile e na le boits'oaro bo fokolang. Ho feta moo, ha li lokise kannete, ha li phekole kapa li thibela ED. Mefokolo ena e tsejoa hantle lebaleng, mme bafuputsi ba bangata ba ntse ba tsoela pele ho lekola mekhoa e ntlafalitsoeng ea kalafo bakeng sa ED e tla fihlela sepheo se phahameng sa kalafo e nepahetseng.
Ho tsoa ka pono ena, moqoqo ona o reretsoe ho hlahisa lintlha tse 'maloa tse kholo tsa tlhahlobo ea biomedical tse ka khothalletsang lingaka tse sebetsang tsa bongaka bakeng sa ED nakong e tlang. Ka kakaretso, litataiso tse joalo li kenyelletsa pharmacotherapy, kalafo ea kholo ea kholo, kalafo ea liphatsa tsa lefutso, le meriana ea ho nchafatsa, kaofela li tsamaisana le tsebo ea tsoelo-pele ea lipheo tsa bohlokoa tsa molek'hule le likarolo tsa tlhaho tsa tlhaho tse hlahileng pele ho mmele oa tlhaho. Ha ke hlahloba lintlha tsena, ke ts'epo ea ka ho fana ka leseli la mekhoa e ts'episang, e tlang le e tlang e tla etsa hore baoki ba sebetse hantle ho feta mefuta ea likhetho tsa bona lefapheng lena.
Pharmacotherapy
Har'a litebello tsa kalafo bakeng sa ED, mokhoa oa ho phekola ka meriana o sebelisitse botumo lilemong tsa morao tjena. Ho bona sena ha ho makatse, kaha ho hlokometsoe taba ea hore li-pharmacologic agents li sebetsa ho kenya limolek'hule tse ling mme ka tsela e 'ngoe li kenya tšebetsong mekhoa e bonts'ang ho hlahisa karabelo ea erectile. Mabapi le sena, mekhoa ea phekolo e atile ho aroloa ka mekhahlelo ea litlamorao le lipakeng tsa ts'ebetso, ha ho buuoa ka tsamaiso ea methapo. Buka ena e boetse e lumela hore melaoana ka kotloloho e kenyelletsa neuroaxis, ka menehelo e tsoang ho li-endocrine le balaoli ba paracrine. Ka bobeli ho ea pele le bohareng, botsamaisi ba pharmacolog hangata bo latela merero ea merero ea dichotomous ea khatello ea methapo ea antirectile kapa ho phahamisa mekhoa ea proerectile, kapa motsoako o mong oa bobeli.
Boemong bo potelletseng bo mabapi le pelvis le botoneng, mehopolo ea hona joale ea mekhoa ea ho hatella mekhoa ea antierectile e kenyelletsa-antrenoceptor antagonists, endothelin receptor antagonists, and angiotensin II receptor antagonists (Andersson, 2001). Leano le tsebahalang haholo la -drenoceptor blockade ho hanyetsa contraction ea adrenergally Mediated ea lithane tsa erectile (Christ et al, 1990). Ho na le ts'ebeliso e tloaelehileng ea tleleniki ea nonspecific --adrenoceptor antagonist phentolamine ka li-regracavernosal pharmacotherapeutic regimens. Khopolo ea ho nts'etsapele bahanyetsi ba li-receptor ant endon bakeng sa endothelin le angiotensin II kaha liphekolo tsa kalafo li ka bonahala li na le boipiletso, mme mohlomong lipatlisiso tsa nako e tlang tsa kliniki li ka hlalosa lits'ebetso tsa bona.
Saense ea morao-rao ea motheo oa molek'hule ea penile erection e netefalitse karolo e kholo ea tsela ea ho emisa ea RhoA / Rho-kinase e le molaoli ea ka sehloohong oa tumellano ea mesifa ea borena ho potoloha le 'mele hammoho le penis (Mills et al, 2001). Tsela e hlile e emela sebaka sa limolek'hule sa lintlafatso bakeng sa babuelli ba contractile (mohlala, norepinephrine, endothelin, le angiotensin II), moo tsela e sebetsang e le motheo oa ts'ebetso ea liketso tsa limolek'hule tsa ba buelli ka methati ea methapo. Ho ipapisitse le tsebo ena e ncha, ho lebelletsoe haholo hore maano a meriana a tla ntlafatsoa a lebileng tseleng ea RhoA / Rho-kinase e kenang ka botoneng. Tsepamiso e ikhethileng bakeng sa nts'etsopele ea pharmacotherapeutic ke hore na ketso ea protheine e khothalletsoang kapa e thibelang lintho ka tsela ena e sebetsa botoneng 'me e ka sebelisoa hampe ho tsamaisa likarabo tsa erectile ka kotloloho ntle le litlamorao tse mpe' meleng (Jin le Burnett, 2006 ).
Maano a potoloha a ho nts'etsapele mekhoa ea proerectile a fapane mme a kenyelletsa nitric oxide (NO) signaling wayway, phosphodiesterase (PDE) inhibitors, prostanoids, cholinergic receptor agonists, peptides vasoactive, and open pot Channelum (Andersson, 2001). Maano ana kaofela a ipapisitse le melao-motheo ea saense ea neurophysiology le biology ea mesifa e boreleli e amanang le botoneng. Ka nako ena, NO / cyclic guanosine monophosphate (cGMP) / cGMP-protein-based protein kinase I pathway e sebetsa e le motheo o ka sehloohong oa taolo ea penile erection (Burnett et al, 2006). Mokhoa ona o fana ka libaka tse ngata tsa limolek'hule bakeng sa ho ts'oaroa ha pharmacologic, ho kenyelletsa li-enzyme tse thusang, li-cofactor le biochemical le lihlahisoa, le li-enzymes tse nyenyefatsang. Tsela ena e se e sebelisitsoe hampe bakeng sa tloaelo ea bongaka. Tse tsejoang haholo ke li-inhibitors tse fumanehang khoebong, ka molomo kapa tse sebetsang ka PDE5 joalo ka sildenafil, vardenafil, le tadalafil (Corbin, 2004). Mekhoa ena ea meriana e sebetsa ka ho thibela liketso tsa mofuta o nyenyefatsang oa PDE5 ka botoneng (bo nyenyefatsang molek'hule oa molaetsa oa bobeli oa NO signaling, cGMP). Ka tsela ena, PDE5 inhibitors e ka hlahisa litlamorao tsa botsitso ba mesifa tseleng ena e saenneng. Nonspecific PDE inhibitor papaverine e sebelisitsoeng haholo ho li-regracavernosal pharmacotherapeutic regimens ke mohlala o mong oa leano lena la kalafo. Bokapele ba tsela ea NO e bonts'ang litsebe ho erection physiology e bonts'a hore e tla tsoela pele ho hohela phaello e le mokhoa oa ho fetola karabelo ea erectile molemong oa bongaka. Bakeng sa bokamoso, bafuputsi ba ka ntšetsa pele mekhoa e meng ea phekolo e thehiloeng ho mekhoa ea sepheo sa limolek'hule tse fetang PDE5 inhibition. Ho khahlisang le ho feta, nts'etsopele ea li-activist tsa "cyanyase cyclase" tse sebetsang ho tsamaisa tsela ea ho saena ntle le ts'usumetso ea NO e ithutile maemong a preclinical ka ts'epo e ka bang teng ea tleliniki (Brioni et al, 2002).
Li-Prostanoids li bontšitsoe ho laola physiology e boreleli ea mesifa ka botoneng, 'me moemeli oa bona oa lik'hemik'hale prostaglandin E1 (eo hape a bitsoang alprostadil) o sebelisitsoe haholo bakeng sa intracavernosal pharmacotherapy ea ED (Cawello et al, 1997). Boithuto bo sa khaotseng ba ho khetholla li-metabolite tsa "prostanoid", li-receptors le mekhoa ea ts'ebetso botoneng e ka lebisa ho maano a bohlokoa a pharmacotherapeutic nakong e tlang. Ketso ea Cholinergic ka botoneng e utloisisoa ho kenya letsoho ho e-ba le penile erection e le mochine oa neuronal o susumetsang tokollo ea endothelial ea lintho tse nyarosang ho kenyeletsa endothelial NO (Andersson, 2001). Tsebo ena e fana ka maikutlo a hore mekhoa ea kalafo e tsamaisang cholinergic ka thobalanong e kanna ea khahla e le leano la kalafo bakeng sa ED. Monyetla oa ho nts'etsapele pharmacotherapy e thehiloeng ho li-neuropeptide le liketso tsa peptide tse nyelisang ka botoneng e lula e le thahasello 'me e hlahisoa ke mosebetsi o matla oa bo-ramahlale o bonts'ang hore lik'hemik'hale tsena li hlile li kenya letsoho ho li-biology tse laolang tsa lithane tsa erectile (Becker et al, 2001; Guidone et al , 2002).
Eketseha ea pharmacotherapy e kanna ea hlahisoa ho tsoa tsebong e ntlafalitsoeng mabapi le thepa ea electrophysiologic ea mesifa e boreleli, ho kenyelletsa mesebetsi ea mocha oa ion o kenyelletsang biology ea mesifa e boreleli. Mekhoa ea phekolo e thehiloeng ho mekhoa ea ion homeostasis ka har'a mesifa ea mesifa e boreleli e shebahala e khahlisa ka lebaka la motheo oa taolo ea mantlha e amanang le mekhatlo ea ionic e khethollang contractility ea li-tiski (Christ et al, 1993). Ho entsoe lithuto tsa pejana tse bonts'ang hore mekhoa ea ho bula li-potasiamo e ka sebelisoa bakeng sa lipilisi tsa pharmacotherapeutic bakeng sa ED (Holmquist et al, 1990; Venkateswarlu et al, 2002).
Pharmacotherapy maemong a mantlha a taolo ea erection e fana ka mokhoa o fapaneng ka ho felletseng taolong ea ED. Khopolo ea hore pharmacotherapeutics ea mantlha e ka sebelisoa hampe bakeng sa botsamaisi ba ED e bonahala e utloahala ka kutloisiso ea hore kakaretso eohle ea erectogenic e susumetsoang kelellong le maqhubu a mokokotlo a elicit penile erection (Giuliano et al, 1995). Le ha ho le joalo, ho rarahana ha mekhoa ea mantlha e tataisang phapang ea mmele oa 'mele, ha ho bapisoa le tsamaiso ea karabelo ena, ho sitisitse likhetho tsa kalafo tse holileng tsa ED. Leha ho le joalo, lits'ebetso tse 'maloa tsa li-neurochemical maemong a lesapo la mokokotlo le supraspinal li bontšitsoe ho bapala likarolo ho karabelo ea erectile. Tse hlahelletseng ho tsena ke 5-hydroxytryptamine (5-HT; serotonin), dopamine, oxytocin, le NO. 5-HT e bile le tšusumetso e matla haholo taolong ea lesapo la mokokotlo oa penile erection. Dopamine e bontšitsoe hantle ka ho fetisisa e le mokena-lipakeng oa 'mele oa penile erection ea sebetsang kahare ho "patho" ea methapo ea methapo ea kutlo (Argiolas le Melis, 2005). Boemong bona, tsamaiso ea oxytocinergic ho lumeloa hore e etsahala motheong oa ho supa dopamine hape e ho saena ka li-neurochemicals tse ling tse kang glutamate, NO, le oxytocin ka boeona. Neurochemistry e theohelang le ho potoloha e ntse e le thata bakeng sa ho tobisoa ho pharmacotherapeutic. Leha ho le joalo, maano a 'maloa a se a fuputsoe setsing sa bongaka. Mohlala, apomorphine e sebetsang e le dopaminergic agonist e entsoe e le moemeli oa litlama oa molomo o sebelisitsoeng ka mokhoa o tlisoang ke lingaka linaheng tse kantle ho United States (Wagner, 2001).
Mochine o mong o ka fetohelang ho oxytocinergic neurons ka hare ho hypothalamic nuclei e emeloa ke tsela ea taolo ea melanocortinergic (Wessells et al, 2005). Ha e le hantle, liketso tsa li-receptor tsa melanocortin li fumanoe kahare ho hypothalamic nuclei, mme Melanotan II ea sebetsang e le nonselective melanocortin receptor agonist e ithutile litekong tsa bongaka tsa pele-pele e le leano le ka 'nang la e-ba le meriana ea ED. Bohlokoa ba taolo ea mantlha ea ntlafatso ea penile hammoho le tsoelo-pele e tsitsitseng lefapheng lena e khothaletsa nts'etsopele ea tsoelo-pele ea tlhaiso ea litlhare maemong a mantlha bakeng sa botsamaisi ba ED.
Pheko ea Factor ea Ho Hola Phekolo ea kholo ea Keketseho e emela leano le leng hape le hlahang bakeng sa kalafo ea ED, ho amohela likarolo tse ka bang teng tsa lintlha tsa ts'ebetso ea lik'hemik'hale ho nts'etsopele le tšebetsong ea biology ea litho tsa thobalano. Phekolo ena e ka bolela ts'ebetso e ka khonehang ea ho kenella ha neuroprotective le vasculoprotective ka boits'oaro ho lebisa likarolo tsa biolo tse amehang karabelong ea erectile e senyehileng ke lefu la neuropathic kapa likotsi. Mosebetsi o pharaletseng oa mosebetsi o bokelletse, haholoholo o sebelisa mehlala ea litekete tsa liteko, e bonts'a li-neurotrophin tse fapaneng, joalo ka ntlha ea kholo ea methapo, kholo ea methapo ea methapo ea methapo ea methapo, le mabaka a amanang le ts'ebetso ea kelello, hammoho le lintlha tsa methapo ea kutlo, tse kang lihormone tsa kholo, morphogenic factor Sonic hedgehog protheine, le cytokine-hormone erythropoietin, e fana ka likarolo tse kholo mesebetsing ea penile neuronal (Podlasek et al, 2005; Bella et al, 2008). Haholo-holo liphuputso li bontšitse hore li-agents tsa neurotrophic li sireletsa kapa li nolofalletsa ho hlaphoheloa ha methapo ea kutlo ea autonomic, ka lehlakoreng le leng e theola sekhahla sa ho fokola ha mesifa ea erectile le ho nts'etsapele ntlafatso ea tšebetso ea erectile. Motheo oa limolek'hule bakeng sa litlamorao tse molemo o ka kenyelletsa mekhoa e mengata, ho kenyelletsa ts'ebetso ea methapo ea methapo ea methapo ea methapo ea mmele le ho kenella ha lintlha, tse lebisang ho kengoloeng ha liprotheine tsa methapo le tsamaiso ea methapo ea methapo.
Thahasello ea Clinical ea ho sebelisa hampe tsoelo-pele ea saense sebakeng sena e kholo. Lipatlisiso tsa liteko li bonts'a hore menyetla e 'maloa e ka sebetsa e le lipheo tse sebetsang tsa ho kenella ha neurobiologic ka botoneng ka sepheo sa ho laola ED. Ka nako ena, ho entsoe mosebetsi oa pele feela maemong a kliniki ho theha likopo tsa mofuta ofe kapa ofe oa lits'ebetso tsa lefu la neurogenic ED. Liteko tsa kliniki li etselitsoe corticosteroids, immunophilin ligands, le tšusumetso ea motlakase, tsohle li fana ka maikutlo a mekhoa e fapa-fapaneng ea ho khanna litla-morao tsa neurotrophic / neuroprotective, leha liphetho li netefalitse polokeho mme ha li e-so ka netefatsa katleho ea kalafo (Burnett le Lue, 2006). Patlisiso e matla e tsoelang pele e ka hlakisa maemo a latelang a likhakanyo kapa mokhoa o hlophisitsoeng oa lithethefatsi o nang le litlamorao bakeng sa maemo a batho. Hoa hlokomeleha hore tataiso ena ea kalafo e fana ka mokhoa oa ho lokisa bothata ba neurogenic ED, ka menyetla ea ho khutlisa ts'ebetso e tloaelehileng ea erectile. Taba ea bohlokoa ke hore na mekhoa ea phekolo e amanang le tšimo ena e ka tsamaisoa ntle le ho baka litlamorao tse mpe tsa likarolo tsa 'mele. Taba ena ke ea bohlokoa ka ho khetheha bakeng sa kalafo ea kholo ea methapo e ka bang teng bakeng sa ho hlophisoa ha kalafo ea maiketsetso, moo ho ka bang le mathata a ho eketseha ha lisele tsa kankere ea mofets'e oa senya ka mora ho buuoa. Ho tla hlokahala hape ho theha mekhoa ea ho laola mokhoa oa phello ena ea kalafo ho kholo ea methapo.
Phekolo ea kholo ea ho hola e hlile e sebetsa ka lebaka la predominance ea lefu la vascular e amang hampe ts'ebetsong ea erectile. Ebile, ho fanoa ka maikutlo a karolo ea khatello ea kelello ea endothelial e le ntho ea bohlokoa ea pathogenic e tlatselletsang ts'ebetso eohle ea lipetlele tsa lefu la pelo. Ho utloisisoa hore vasotine endothelium e ka hare ho vasculature ea penile e bohlokoa bakeng sa lits'ebetso tsa tlhaho ho tloha molaong oa hemodynamic ho isa ho homeostasis ea vascular.
Mosebetsi oa bohlokoa oa ho etsa liteko sebakeng sena, o sebelisang mehlala ea liphoofolo tse ikhethang, o hlakisitse karolo ea lintlha tsa angiogenic le litlamorao tsa eona tsa trophic ts'ebetsong ea mesifa e boreleli ea cell cell penis (Burchardt et al, 2005; Xie et al, 2008). Ho ithutile lintlha tse ngata tsa limolek'hule, joalo ka sesosa sa kholo ea methapo ea methapo le kholo ea motheo ea kholo ea "fibroblast". Phetolelo ea lithuto tsena bakeng sa kalafo ea kalafo ea vasculogenic ED e fumane ho tsitsipana lilemong tsa morao tjena, 'me liteko tsa nako e tlang tsa tleliniki li na le ts'episo ea hore mofuta ona oa kalafo ea kholo ea kholo o tla ba molemo. Morero oa ho khutlisetsa kapa ho khothaletsa methapo ea methapo ea methapo / endothelial kahare ho botoneng e ea ipiletsa. Hoa tšoana le boemo ba kalafo ea methapo ea methapo, mekhoa ea phekolo bakeng sa kholo le tšebetso ea penile vasculature e fana ka monyetla oa ho khutlisa tšebetso e tloaelehileng ea erectile.
Gene Therapy Phekolo ea Gene e fana ka maikutlo a mokhoa oa fisiks ea saense mabapi le ho laola ED. Leha ho le joalo, mokhoa ona o kanna oa emela sebaka se secha bakeng sa taolo ea bothata bona, ka melemo e ka bang teng bakeng sa thibelo ea ED kapa esita le ho hlaphoheloa ha ts'ebetso ea erectile sefahleho sa maloetse e re kotsi ho bophelo ba penile (Strong et al, 2008). Mohopolo ona o bua ka kenyelletso ea liphatsa tsa lefutso tse tsoang liseleng tsa motho tse khutlisetsang kapa tse tlatselletsang ts'ebetso ea cellular e nang le phoso kapa ka mokhoa o ts'oanang e sebetsana le litlamorao tsa ts'ebeliso ea mofuta oa phetoho ea liphatsa tsa lefutso. Bolo ba botoneng bo emela sebaka se loketseng bakeng sa kalafo ea liphatsa tsa lefutso, ka lebaka la sebaka sa eona sa kantle le monyetla oa ho sebelisa liphatsa tsa lefutso tse sebetsang. Ntle le moo, litaba tsa parenchyma tse fumanehang hoses of the penis li fana ka maikutlo a hore phumants'o e ka tlisoa le ho qhalakana e sa fetoheng. Tsela eo kalafo ea gene e sebetsang ka eona e hloka hore karoloana feela ea lisele e fetoloe, 'me e fuoe thepa ea karabelo ea litho tsa erectile eo ka eona phello ea phepelo e ka fetisoang ka bongata ke liphapang tsa lisele tse bonolo tsa mesifa, penis ke setho se khahlehang ho e leng ho phehella kalafo ya gene.
Mekhoa ea phekolo ea Gene e arotsoe ho latela meralo ea bona ea phepelo, ka vaerase (mohlala, li-adenoviruse, livaerase tse amanang le adeno, li-retrovirus) kapa li-nonviral (mohlala, DNA e hlobotseng, DNA ea plasmid, liposomes) kapa li-cell tse ling tse thehiloeng ka bongata (mohlala, myoblasts, lisele tsa endothelial) litsamaiso tsa lits'ebeletso (Christ le Melman, 1998). Karolo eo e utloisisoa hape ka ho latela litšobotsi tse joalo ka ts'ebetso ea phetisetso, ho tšoarella le boemo ba polokeho. Litholoana tsa vaerase ka kakaretso li fana ka katleho e kholo ea phetisetso ea seleng. Le ha ho le joalo, lits'ebetso tsena li ka baka likarabo tsa mmele tsa ho itšireletsa mafung le tsa ts'oaetso, tse hlahisang litlamorao tse tlatselletsang. Ho boetse ho na le matšoenyeho a ho kenyelletsoa ha ho kenella ha DNA ho genome e amohelang le ts'ebetso e latelang ea oncogene. Litholoana tse se nang tšoaetso, ho fapana le moo, li na le likotsi tse tlase tsa likarabo tsa ho itšireletsa mafung kapa tsa tšoaetso. Phekolo ea liphatsa tsa lefutso ea sele e fana ka tlhahiso e tsitsitseng ea tlhaiso-leseling ea lefutso ka koloi e fetotsoeng ea cellular mme e itšetleha ka ho khomarela le ho phehella ha sele ka har'a lithane tse kenyellelitsoeng. Mekhoa e mengata ea kalafo ea gene bakeng sa botoneng e filoe lipatlisiso tse ngata boemong ba preclinical. Tsena li kenyelletsa li-vektori tse fapaneng le mekhoa hammoho le limolek'hule tse fapaneng tsa erectogenic tse tsamaisitsoeng. Har'a limolek'hule, vascular endothelial grow factor, NO synthase, preprocalcitonin gene-amanang le peptide, vasoactive intestinal peptide, brain-based neurotrophic factor, le calcium-sensitive potasiamo (maxi-K) e ithutile. Mokhoa o boletsoeng ka mokhoa o bonolo o bonts'itse katleho ho tataiseng likarabo tsa bokhoni ba mefuta ea liphoofolo tsa ED. Ka lebaka leo, li fana ka bopaki ba mohopolo oa hore phekolo ea liphatsa tsa lefutso e ka sebetsa maemong a lingaka ho banna ba nang le ED mme ba fana ka maikutlo a hore litsela tse fapaneng tsa limolek'hule tse tsamaisang karabelo ea lithane tsa erectile li ka sebelisoa hampe ho hlahisa penile erection.
Ho makatsang ke hore mekhoa ea phekolo ea liphatsa tsa lefutso e sa tsoa ithutoa khafetsa boemong ba bongaka. Teko ea bongaka ea Karolo ea I eo ho eona gene ea maxi-K e tlisitsoeng ke DNA plasmid e bonts'itse litlamorao tsa ts'ireletso le mohlomong melemo ea ho sebetsa hantle (Melman et al, 2006). Teko ena e ne e na le palo e fokolang feela ea bakuli ebile e sa kenye letsoho la taolo. Kahoo, likahlolo tse hlakileng mabapi le katleho ea phekolo ea liphatsa tsa lefutso ho batho ho phekola ED li lula li lekantsoe. Leha ho le joalo, thuto ena e fane ka thahasello e lekaneng ho tsosa lipatlisiso tse eketsehileng sebakeng sena.
Tsamaiso ea nako e tlang ea ED e itšetlehileng ka tebello ea mefuta ea phekolo ea gene e nkoa haholo. Hoa khahlisa ho fana ka maikutlo a kalafo e ka bang le litlamorao tsa nako e telele ho laoleng kapa ho thibeleng ED. Khetho ena e kanna ea nahanoa hammoho le mekhoa e meng ea kalafo, ka tsela eo, ea fokotsa litekanyetso tsa litekanyetso le ho fokotsa litlamorao tse amanang le kalafo e meng. Ka ts'episo ena ea nako e tlang, ho bohlokoa ho amohela liphephetso tse tsoelang pele mme ho tla hlokahala hore li felisoe ho tlisa pheko ena. Ho tla hlokahala hore ho fanoe ka tlhokomelo mabapi le khetho ea lihlahisoa tse khethiloeng tsa gene kapa motsoako oa eona o tla ba le thuso e pharaletseng kapa o ka ba molemo ho tlhaiso-leseling ea ED. Ntle le moo, ho tla hlokahala ho hlola litšitiso tsa polokeho, tse amanang le taolo ea kalafo ea gene ka kakaretso maemong a kliniki.
Meriana ea Bochafatso Mehopolo ea ho aha bocha lithane e sebelisitsoe ho batho ba tlholeho ba ikarabellang bakeng sa ho bokellana ha penile. Ka hona, moriana o ntlafatsang oa penis o bolela mekhoa e simolohang ho tloha ho boenjiniere ba tishu ho ea ho stem cell tiba, e etselitsoeng ho nchafatsa lisele tse loketseng karabelo ea erectile ho tloha methapo ea penile ho ea ho corpus cavernosum ka boeona.
Mosebetsi oa mahlale lefapheng la tokiso ea methapo kapa ho kopanya methapo ea kutlo ea penile o entsoe esale pele le ka bongaka ka thahasello ea mantlha bakeng sa ts'ebeliso ea post-radical prostatectomy ED (Burnett and Lue, 2006). Khopolo ke ho fana ka sebaka sa sebaka sa methapo ea kutlo e lemalang kapa e ntle e ka hlahang nakong ea methapo ea kutlo. Mekhabiso ea methapo ea methapo e se e hlalositsoe, ho tloha mehahong ea methapo ea methapo ea methapo ho ea ho litlhaku tsa methapo ea methapo, e ka kenellehang nakong ea ts'ebetso ea polokelo ea penile ea tsamaiso. Ka tekanyo e kholo, tsoelo-pele e se e entsoe ho khutlisetsa lisele tsa khampani, tse ka bang le likopo maemong a tleleniki a tahlehelo e kholo ea tahlehelo ea penile tiske (Falke et al, 2003). Tlhahlobo ena ea kalafo e kopanya boenjiniere ba likarolo tsa botsitso tsa likhoebo le mekhoa e tsoetseng pele ea phepelo bakeng sa liphatsa tsa lefutso le lintlha tsa kholo tse khothaletsang psychanogeneis. Leha ho na le mmele o khahlisang oa mosebetsi oa mantlha o kileng oa etsoa, tsoelo-pele e eketsehileng e hlokahala ho tlisa maikutlo a moriana o ntlafatsang lebaleng la bongaka bakeng sa taolo ea ED. Monyetla oa ts'ebetso ea ho hokahanya mohopolo bakeng sa ho khutlisetsa methapo ea kutlo ea penile e utloisisoa e le kannete, leha tšehetso e khotsofatsang ea katleho ea ts'ebetso ena ea bongaka e ntse e sa hlaka. Bakeng sa ho aha bocha lithane tse kopanetsoeng, ho tla hlokahala sepheo se seholo ho phethahatsa litlhoko tsa moralo, biomeological le tšebetso ea li-cavernosa tsa khale tsa khoebo. Nts'etsopele ea likoloi tsa phano ea lisele le lijana bakeng sa liphatsa tsa lefutso le lintlha tse hlokahalang bakeng sa lisele tsa penile tse sebetsang e tla ba karolo ea mantlha ho nts'etsapele mokhoa ona oa kalafo.
Summary
Ho tloha mehleng ea khale ho fihlela joale, botsamaisi ba ED bo hatetse pele haholo. Mekhoa ea phekolo ea nalane e simolohileng ho tsoa lithutong tse sa tloaelehang haeba e se litumelo tsa mohopolo mabapi le maikutlo, lihormone, kapa mabaka a lik'hemik'hale a amang pherekano ea penile. Ntle le moo, ho ile ha hlahisoa lisebelisoa tsa mochini, tse sitisang kutloisiso ea mahlale a mekhoa ea ho hlophisa lintho, leha li hlahisitse mokhoa o sebetsang oa ho tiea ha botoneng ha ho hlokahala bakeng sa thobalano. Haufinyane tjena, patlisiso ea baeloji e potileng sehlooho sena e hlahisitse kutloisiso e tsoetseng pele ea saense ea karabelo ea erectile. Patlisiso ena e kentse letsoho ho tsa bongaka tse fanang ka morero oa mahlale bakeng sa ED, 'me ha mosebetsi o joalo o ntse o tsoela pele ka potlako, mohato o mocha o thehiloe bakeng sa ho nts'etsapele likhetho tsa kalafo tse ka' nang tsa lokisa kapa hona ho thibela ts'ebetso ena ea thobalano. Likarolo tse 'maloa tsa tsoelo-pele ea kalafo li bonahala, ho kenyeletsoa litlhare tsa litlatse, mofuta oa kalafo ea kholo ea kalafo, kalafo ea liphatsa tsa lefutso, le meriana ea ho nchafatsa. Har'a lintlafatso tsena tsa saense tse thabisang, bokamoso ba botsamaisi ba ED bo tletse ts'episo.
Mongolo o botlaaseng ba leqephe
Pampiri ena e ipapisitse le nehelano Sebokeng se Ikhethileng sa la 12 Mmesa 2008, "Mekhoa ea Phekolo ea Bophelo bo Botona ba Botona le Botšehali ba Banna", e amanang le Mokhatlo oa Selemo le Selemo oa Mokhatlo oa Amerika oa Andrology, oo mongoli ea hlahisang a ileng a fuoa tlotla.
Ngaka Burnett o na le likamano tsa boeletsi le / kapa tsa lichelete le Pfizer, Eli Lilly le Co, le American Medical Systems, Inc.
References Andersson KE. Pharmacology ea penile erection. Pharmacol Rev. 2001; 53: 417--450. [Abstract / Free Full Text]
Argiolas A, Melis MR. Taolo e bohareng ea erection ea penile: karolo ea karolo e ka sehloohong ea potoloho ea hypothalamus. Prog Neurobiol. 2005; 76: 1 -21. [CrossRef] [Medline]
Becker AJ, Uckert S, Stief CG, Truss MC, Machtens S, Scheller F, Knapp WH, Hartmann U, Jonas U. Karolo e ka khonehang ea bradykinin le angiotensin II taolong ea penile erection le detumescence. Urology. 2001; 57: 193 -198. [CrossRef] [Medline]
Bella AJ, Lin G, Cagiannos I, Lue TF. Limolek'hule tse hlahang tsa neuromodulatory bakeng sa kalafo ea dysfunction ea neurogenic erectile e bakoang ke ho lemala ha methapo ea methapo ea methapo. Asia J Androl. 2008; 10: 54 -59. [CrossRef] [Medline]
Brioni JD, Nakane M, Hsieh GC, Moreland RB, Kolasa T, Sullivan JP. Basebelisi ba cyclase ea soluble guanylate cyclase bakeng sa kalafo ea dysfunction ea banna. Int J Impot Res. 2002; 14: 8 -14. [CrossRef] [Medline]
Burchardt M, Burchardt T, Anastasiadis AG, Buttyan R, de la Taille A, Shabsigh A, Frank J, Shabsigh R. Ts'ebeliso ea lintlha tsa angiogenic bakeng sa ho phekola ho se sebetse hantle ka botlalo: ho fetisoa hoa protheine le DNA ea VEGF 165 ka penis. Urology. 2005; 66: 665 -670. [CrossRef] [Medline]
Burnett AL, Lue TF. Pheko ea Neuromodulatory ea ho ntlafatsa sephetho sa ho khutlisa ts'ebetso ea erectile ka mor'a ho buuoa ka pelvic. J Urol. 2006; 176: 882 -887. [CrossRef] [Medline]
Burnett AL, Musicki B, Jin L, Bivalacqua TJ. Leqhubu la nitric oxide / redox-e thehiloeng e le sepheo sa kalafo bakeng sa mathata a penile. Litsebi tsa Opin Ther. 2006; 10: 445 -457. [CrossRef] [Medline]
Cawello W, Schweer H, Dietrich B, Seyberth HW, Albrecht D, Fox A, Hohmuth H. Pharmacokinetics of prostaglandin E1 le metabolites ea eona e ka sehloohong ka mor'a ho kenella ka entracavernous le ho kenngoa ha nakoana ha prostaglandin E1 ho bakuli ba nang le bothata ba ho hlobaela ho sa sebetseng ha mmele. J Urol. 1997; 158: 1403 -1407. [CrossRef] [Medline]
Christ GJ, Brink PR, Melman A, Spray DC. Karolo ea likotlo tsa likheo le likonopo tsa ion mochineng oa lipontšo tsa motlakase le lik'hemik'hale ka har'a mesifa ea motho ea corpus cavernosum. Int J Impot Res. 1993; 5: 77 -96. [Medline]
Christ Christ GJ, Maayani S, Valcic M, Melman A. Litlhahlobo tsa meriana ea lithaelese tsa motho tse amanang le sethoathoa: litšobotsi tsa ho itšunya-tšunya ha mokokotlo le liphetoho lipuisanong tsa alpha-adrenoceptor le lilemo le lefu ho li-tishu tse ikhethileng. Br J Pharmacol. 1990; 101: 375 -381. [Medline]
Christ GJ, Melman A. Ts'ebeliso ea mofuta oa kalafo ea kalafo ho kalafo ea dysfunction ea erectile. Int J Impot Res. 1998; 10: 111 -112. [CrossRef] [Medline]
Corbin JD. Mekhoa ea ts'ebetso ea thibelo ea PDE5 ts'ebelisong ea erectile dysfunction. Int J Impot Res. 2004; 16 (suppl 1): S4 -S7. [CrossRef] [Medline]
Falke G, Yoo JJ, Kwon TG, Moreland R, Atala A. Ho hlophisoa ha meralo ea likhoele tsa khoebo ho vivo o sebelisa mesifa ea sefahleho sa motho le lisele tsa endothelial tse lenngoeng matrolong a collagen. Moferefere Eng. 2003; 9: 871 -879. [CrossRef] [Medline]
Giuliano FA, Rampin O, Benoit G, Jardin A. Tsamaiso ea tlhaho ea tlhaho. Urol Clin N Am. 1995; 22: 747 -766. [Medline]
Guidone G, Müller D, Vogt K, Mukhopadhyay AK. Tšoaetso ea li-receptor tsa VIP le PACAP ho lisele tse boreleli tsa rat penis Corpus cavernosum mesifa e boreleli le ho sebelisana ha tsona le li-receptor tsa guanylate cyclase-B. Regul Pept. 2002; 108: 63 -72. [CrossRef] [Medline]
Holmquist F, Andersson KE, Favaeus M, Hedlund H. K (+) - li-open openers tsa phomolo ea lithane tse ikhethileng tsa penile erectile ho tsoa ho mmutla. J Urol. 1990; 144: 146 -151. [Medline]
Jin L, Burnett AL. Rho1 / Rho-kinase ho lithane tsa erectile: mekhoa ea mafu le temohisiso ea kalafo. Clin Sci (Lond). 2006; 110: 153 -165. [Medline]
Melman A, Bar-Chama N, McCullough A, Davies K, Christ G. hMaxi-K gene fetisetsa ho ba batona ba nang le bothata ba ho se sebetse hantle: diphetho tsa nyeoe ea pele ea motho. Hum Gene Ther. 2006; 17: 1165 -1176. [CrossRef] [Medline]
Mills TM, Chitaley K, Wingard CJ, Lewis RW, Webb RC. Matla a thibelo ea Rho-kinase ho vasoconstriction ho potile potoloha. J Appl Physiol. 2001; 91: 1269 -1273. [Abstract / Sengolo se Felletseng sa Mahala]
Litsi tsa Naha tsa Bophelo. Ho hloka matla. Polelo ea NIH Consensus. Bethesda, MD: Setsi sa Naha sa Bophelo; 1992; 10: 1 -33.
Podlasek CA, Meroz CL, Korolis H, Tang Y, McKenna KE, McVary KT. Sonic hedgehog, botoneng le ho se sebetse hantle ka botlalo: ho hlahloba moraic hedgehog ho supa ka botoneng. Curr Pharm Des. 2005; 11: 4011 -4027. [CrossRef] [Medline]
TD e matla, Gebska MA, Burnett AL, Champion HC, Bivalacqua TJ. Endothelium e ikhethang gene le kalafo e thehiloeng ho lisele bakeng sa ho se sebetse hantle ha erectile. Asia J Androl. 2008; 10: 14 -22. [CrossRef] [Medline]
Venkateswarlu K, Giraldi A, Zhao W, Wang HZ, Melman A, Spektor M, Christ GJ. Lithane tsa potasiamo le methapo ea lentsoe ea mesifa e boreleli ea batho: lefu la tsoekere le boikhathollo ba mesifa ea motho ea cosus cavernosum e boreleli ke adenosine triphosphate potassium e hlokolosi ea potasiamo le liteishene tse bulehileng. J Urol. 2002; 168: 355 -361. [CrossRef] [Medline]
Wagner G. Apomorphine SL (Uprima): kalafo e ncha bakeng sa taolo ya dysfunction ea erectile. Int J Impot Res. 2001; 13 (suppl 3): S1 -S2.
Wessell H, Blevins JE, Vanderah TW. Melanocortinergic taolo ea penile erection. Li-peptide. 2005; 26: 1972 -1977. [CrossRef] [Medline]
Xie D, Annex BH, Donatucci CF. Mabaka a ho hola bakeng sa ho phekola angiogene ea mafu a hypercholesterolemic erectile dysfunction. Asia J Androl. 2008; 10: 23 -27. [CrossRef] [Medline]
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