Mekhoa ea Bohareng ea ho Sebetsane le Erectile: Ke Ngaka efe eo U ka e Tsebang (2003)

Mekhoa e Bohareng ea ho Eketsoa ke Erectile Dysfunction: Seo Kliniki e ka 'nang ea Batla ho se Tseba

Tlaleho ea Machaba ea Lipatlisiso tsa Impotence (2003) 15, Suppl 2, S3-S6. Doi: 10.1038 / sj.ijir.3900989
CG Stief1

1Medical School Hannover, Lefapha la Urology, Hannover, Jeremane

inahaneloang
Khokahano pakeng tsa lisebelisoa tse poteletseng le tse bohareng tsa tšebetso ea erectile ha e hlakisoe hantle leha saense ea mantlha e ntse e tsoela pele sebakeng sena. Ho bohlokoa ho tloha ponong ea bongaka ho utloisisa mekhoa ena e le hore re ka qala ho etsa tsoelo-pele e eketsehileng ea kalafo kalafong ea ho hlobaeleha ha 'mele (erectile dysfunction (ED)). Hona joale ho utloisisoa haholo hore disinhibition ea mantlha e bapala karolo ea bohlokoa ho kenngoeng ha likarabo tsa erectile mme sena se lebisitse ho nts'etsopele ea mothehi ea bohareng, apomorphine SL (Ixense ™) [apo SL]. Apo SL e sebetsa ka har'a "solarricular" nucleus ea hypothalamus e le dopamine receptor agonist. E sebetsa e le setsi sa maemo maemong a ho eketsa likarabo tsa tsela ea erectile ka mor'a ts'usumetso e nepahetseng ea thobalano. Mokhoa ona o ikhethang oa ts'ebetso eaapo SL o ipakile o sebetsa hantle ho bakuli ba 70% le hoja ho phehella ho ka hlokoa ho hlahisa phello e matla bakeng sa palo e phahameng ea bakuli.

Selelekela
Leha lits'ebetso tse kahare ho ts'ebetso ea erectile li sa utloisisoe ka botlalo, tsoelo-pele e entsoe mabapi le ho hokahanya mekhoa e bohareng le e bohareng. Ho utloisisa mekhoa ena ka mahlale a motheo ho bohlokoa haeba ho batla meriana e sebetsang ho phekola mathata a ts'ebetso ea thobalano a kang erectile dysfunction (ED) ho atleha. Nts'etsopele ea sehlopha sa lithethefatsi tse tsejoang e le ba qalisang bohareng ba maiketsetso joalo ka SL e fane ka tlatsetso e sebetsang ho arolelanoang ka urologist, leha ho le joalo mosebetsi o eketsehileng o ka thusa ho tsebahatseng lintlha tse ling tse ka sebetsang hantle tsa ho kenella tseleng ea tšebetso ea erectile.

Taolo e bohareng ea ts'ebetso ea erectile
Mekhoa e bohareng, supraspinal le mokokotlo, e bapala karolo ea bohlokoa ts'ebetsong ea erectile (Setšoantšo sa 1). Erection ea 'tlhaho' e qalisoa bokong ka lebaka la ts'usumetso ea thobalano e hlokang ho sebetsoa le ho hokahanngoa molemong oa ho qala karabelo e nepahetseng ea erectile. Lits'oants'o tse bonts'ang, tse bobebe, tse bonolo le tse nahannoeng tse tsoang ho lobe ea occipital, rhinencephalon, thalamus le limbic system, ka ho latellana, li kopantsoe le ho sebetsoa ho ba likarabo tsa erectile ka li-nuclei tse peli tse nyane tsa hypothalamic, nucleus ea paraventricular (PVN) le sebaka se bohareng sa preoptic (MPOA).

Setšoantšo sa 1.
Masapo a mokokotlo le lesapo la mokokotlo
Karolo ea MPOA ke ho amohela lintlha tse susumetsang tse tsoang litsing tse phahameng tsa boko le ho li kopanya le takatso ea thobalano le mananeo a makoloi a pharalletseng.1 MPOA e nka karolo boits'ebetsong ba bo mme, 2 thermoregulation3 le lenyora.4 PVN e bapala karolo ea bohlokoa ho Karabelo ea erectile, le ts'usumetso ea meriana kapa ts'usumetso ea motlakase ea "hypotalamic nuclei" e nyane e etsa hore ho se sebetsane seminal ho rats5 le erection le ejaculation ka li-rats.6 Dopaminergic neuropene e leng likarolo tsa mantlha tsa PVN. Li-neurones tsena tsa dopaminergic li kenya letsoho ho oxytocin e nang le li-neurones.7

Ho sebetsana le lesapo la lesapo la mokokotlo la karabelo
Li-Neurones tse tsoang PVN li theoha ho fihlela bohareng ba 'mele,' me ka nako ena, li-nucleus paragigantocellularis li ka sitisa matšoao a proerectile ho tsoa libakeng tse phahameng tsa boko haeba ho ka se be le karabelo ea erectile.8,9 Sena se kopantsoe ka mochine oa serotinergic leha li-receptor subtypes li ameha. ha e so hlakisoe ka botlalo.8 Hang ha motho a le bohareng ba boko, matšoao a erectile a feta khoele ea lesapo la mokokotlo. Ntle le ho fetisetsa lipontšo tsa neural, lesapo la lesapo la mokokotlo le na le karolo e kopanyang likarolo ho tsoa libakeng tse haufi le tse bohareng. Hona le libaka tsa mantlha tsa ho hokahanya tšebetso ea erectile ka mokokotlong oa lesapo la mokokotlo, setsi sa thapelo sa thapelo sa ntlafatso ho tloha S2 ho S4 le setsi sa tlhaiso-leseling se tsoang ho T11 ho ea L2.10 Erectile matšoao a tlohela CNS litsing tsena tse peli, mme tlhahisoleseling li fetisoa. ka li-neurones tsa autonomic ho ea periphery.

Litla-morao tsa neuropransmitters
Hona le li-neurotransmitters tse 'maloa tse amanang le taolo ea li-erections. Parasympathetic nitric oxide (colocalised e nang le acetylcholine) ts'ebetso ea bolulo e baka boikhathollo mme e fella ka ho rerection, 10 athe noradrenergic e utloisang kutloelo-bohloko ea infadesergence.11 Li-neurotransmitters tse ling tse amehang taolong ea ts'ebetso ea erectile li kenyelletsa nitric oxide le peptide e nyarosang. Ketsahalo ea bohlokoa e khathollang ho keneng ha erection ke boikhathollo ba lisele tse bonolo tsa mesifa leboteng la Corpus cavernosum. Ketso ena e qaliloe ho arabela nitric oxide e bakang ho phahama ha man messengersosa a bobeli a makatsang a kang cAMP le cGMP, 'me qetellong e hlahise calcium efflux e tsoang liseleng le phomolong.12

Karolo ea dopamine e bohareng mosebetsing oa erectile
Ho na le li-neurotransmitter tse 'maloa tse bohareng le tse amanang le ts'ebetso ea ho qala meropa; e 'ngoe ea li-neurotransmitter tsa bohlokoa joalo ke dopamine. Dopamine ke eona phetisetso e ka sehloohong kahare ho PVN, 5 eo, joalo ka ha ho tšohliloe ka holimo, e bapala karolo ea bohlokoa taolong e bohareng ea erection. Li-receptor tsa Dopamine li arotsoe ka malapa a mabeli a mantlha: D1- le D2-receptors tse arohantsoeng le D1 ho isa D5. Apo SL e na le tšebelisano e phahameng ea D2-like receptors13 tseo ho nahanoang hore ke sona sebaka sa mantlha sa ho kenyelletsa li-erections ho PVN.14 Apo SL e romelloa ho eketsa likarabo tsa erectile ka ho sebetsa joalo ka boemo ba PVN ho susumetsoa ke thobalano e bakang li-erections tse ntlafalitsoeng tse lebisitsoeng ho periphery.15

Ho sebetsa hantle ha Clinical of apo SL
Potso e latelang e sala, mokhoa o ikhethileng oa tšebetso le saense ea motheo e boletsoeng kaholimo e fetolela tloaelo ea bongaka? Bopaki ba karolo e behiloeng bakeng sa moo SL ts'ebetsong ea li-erections bo bokelitsoe nakong ea liteko tse ngata tsa bongaka. Ho feta banna ba 5000 lefatšeng ka bophara ba kentse letsoho litekong tsena, ba fumana li-doses tse fetang 120 000.16 Bakuli bana ba bontšitse palo e pharaletseng ea bakuli ba ED. Banna ba nang le mathata a kopaneng a kang benign Prostatic hyperplasia, lefu la methapo ea mokokotlo le lefu la tsoekere ba kentsoe.16 Ho ekelletsa moo, banna ba nang le mekhahlelo e fapaneng ea ED, ba bonolo, ba itekanetseng ebile ba tebile, joalo ka ha ba hlahlojoa ba sebelisa Index ea Machaba ea Erectile Function (IIEF) ba ngolisitsoe lenaneong la teko ea bongaka. Ntlha ea mantlha ea liteko tsena tsa tleliniki e ne e le liperesente tsa liteko tse ileng tsa baka keketseho e lekaneng bakeng sa thobalano. Liphetho tsa bobeli e ne e le liteko tsa liperesente tsa thobalano le khotsofalo ea balekane, tseo ka bobeli li leng bohlokoa haholo tleleniking. Ts'ebetso ea tlhahlobo e sebelisitse li-diaries tsa bakuli le sekala sa litekanyetso tse kang IIEF.17

Apo SL e ipakile e sebetsa hantle ho ED, haholo ho bakuli ba nang le bakuli ba bonolo ba 'mele ho isa li-ED.16 Hoo e ka bang karolo ea bobeli ho tse tharo ea bakuli (Setšoantšo sa 2) ba tla ba le karabelo e ntle ho erectile ka hare ho metsotso ea 20 ea pele ea ho sebelisa moriana leha bakuli ba bang e tla hloka nako e telele (Setšoantšo sa 3) .16 Ho sebetsa hantle ha SL ho ntlafala ho etsa hore ho be le dosing e ngata; ka hona, ho hlokahala bonyane litekanyetso tse 'ne ho fihlella thobalano. Kamora liteko tse 'ne, karabelo e matla, ka keketseho e habeli ea liperesente tsa li-erections tse lekaneng ho ts'oaroa ha ho bapisoa le placebo, e ka lebelloa ka bonyane 70% ea bakuli ba arabelang (Setšoantšo sa 4) .18

Summary
Disinhibition e bohareng e bapala karolo ea bohlokoa ho kenyeng bokhoni ba morusu. Hona le meaho e 'maloa e bohareng e kentsoeng ho tloha litsing tse phahameng tsa cortical ho isa ho li-hypothalamic nuclei, haholo-holo PVN. Ho hlohlelletsoa ha li-receptor tse kang D2 tse tšoanang le PVN ho na le phello ea proerectile. Ke eona tšusumetso ena ka D2 agonist apo SL e hlahisang ts'ebetso ea eona ea bongaka ho banna ba nang le ED.

Ho sebetsa hantle ha kliniki ea moo SL ho bontšitsoe ka mokhoa o hlakileng nakong ea liteko tsa tleliniking tse sa boneng habeli ho banna ba 5000 ba nang le li-degrees tse fapaneng tsa ED ho tloha ho tse bonolo ho isa ho tse matla. Lithuto tsena li bontšitse keketseho e menahaneng habeli lekholong ea li-erections tse lekaneng ho ts'oaroa ha li bapisoa le placebo le hore moo SL e sebetsa hantle ho banna ba nang le ED e bonolo le e itekanetseng. Ho qala ka potlako hoa ts'ebetso ea apo SL, ho etsahalang ka hare ho metsotso ea 20 bakeng sa bakuli ba bangata ho ka thusa banna ba nang le ED ho ntlafatsa mokhoa oa ho itlhala bolutu likamanong tsa bona tsa thobalano. Katleho ea apo SL e eketseha ka dosing e latellanang ho bakuli ba tšehetsang kalafo e fetang tekanyetso e mene. Mokhoa ona oa kalafo o fa bakuli monyetla oa ho fumana tšebetso e khotsofatsang ea thobalano.

References
1. McKenna KE. Taolo e bohareng ea penile erection. Int J Impot Res 1998; 10 (Suppl 1): S25-S34. | Sengoloa | E phatlalalitsoe |
2. Numan M. Neural motheo oa boitšoaro ba bo-mme ka hara rat. Psychoneuroendocrinology 1988; 13: 47–62. | E phatlalalitsoe |
3. Kanosue K, Zhang YH, Yanase-Fujiwara M, Hosono T. Hypothalamic network bakeng sa ho thothomela hoa thermoregulatory. Ke J Physiol 1994; 267: R275-R282. | E phatlalalitsoe |
4. Bourque CW, Oliet SH, Richard D. Osmoreceptors, osmoreception, le osmoregulation. Front Neuroendocrinol 1994; 15: 231–274. | Sengoloa | E phatlalalitsoe | ISI | ChemPort |
5. Eaton RC et al. Li-receptors tsa D2 ka har'a potoloho ea potoloho ea limela li laola likarabo tsa setho sa botšehali le ho li kopitsa ho likhoto tsa banna. Pharmacol Biochem Behav 1991; 39: 177-181. | Sengoloa | E phatlalalitsoe | ISI | ChemPort |
6. Chen KK, Chan SH, Chang LS, Chan JY. Ho nka karolo ha "potency" ea li-hypothalamus ho tsamaiso ea mantlha ea penile erection ho rat. J Urol 1997; 158: 238–244. | Sengoloa | E phatlalalitsoe | ISI | ChemPort |
7. Buijs RM, Geffard M, Pool CW, Hoorneman EM. Dopaminergic innervation ea supraoptic le paraventricular nucleus. Boithuto bo bobebe le ba elektrone. Brain Res 1984; 323: 65-72. | E phatlalalitsoe |
8. Marson L, McKenna KE. Ts'oaetso ea setsi sa ts'ebetso ea ts'ebetso ea kelello e laolang litlokotsi tsa thobalano mokokotlong ho banna. Brain Res 1990; 515: 303-308. | Sengoloa | E phatlalalitsoe | ISI | ChemPort |
9. Marson L, McKenna KE. Karolo ea li-hydroxytryptamine tsa 5 ho theohelang thibelo ea maikutlo a thobalano le mokokotlo. Exp Brain Res 1992; 88: 313–320. | Sengoloa | E phatlalalitsoe | ISI | ChemPort |
10. Giuliano FA, Rampin O, Benoit G, Jardin A. Tsamaiso ea tlhaho ea tlhaho. Urol Clin North Am 1995; 22: 747-766. | E phatlalalitsoe | ISI | ChemPort |
11. Andersson KE, Hedlund P, Alm P. Sympathetic pathways and adrenergic innervation of penis. Int J Impot Res 2000; 12: S5-S12. | Sengoloa | E phatlalalitsoe | ISI |
12. Wagner G, Mulhall J. Pathophysiology le tlhahlobo ea dysfunction ea banna. BJU Int 2001; 88 (Suppl 3): 3-10. | Sengoloa | E phatlalalitsoe |
13. Argiolas A, Hedlund H. The pharmacology and Clinic pharmacokinetics of apomorphine SL. BJU Int 2001; 88 (Suppl 3): 18–21. | Sengoloa | E phatlalalitsoe |
14. Chen KK, Chan JY, Chang LS. Dopaminergic neurotransication ho paraventricular nucleus ea hypothalamus ho taolo e bohareng ea penile erection ho rat. J Urol 1999; 162: 237–242. | Sengoloa | E phatlalalitsoe | ChemPort |
15. Rampin O. Mokhoa oa ts'ebetso oa kalafo e ncha ea molomo bakeng sa ho se sebetse hantle ha erectile dysfunction: apomorphine SL. BJU Int 2001; 88 (Suppl 3): 22–24. | Sengoloa | E phatlalalitsoe |
16. Mirone VG, Stief CG. Ho sebetsa hantle ha apomorphine SL ho erectile dysfunction. BJU Int 2001; 88 (Suppl 3); 25-29. | Sengoloa | E phatlalalitsoe |
17. Altwein JE, Keuler FU. Phekolo ea molomo ea ho se sebetse hantle ha erectile dysfunction ka apomorphine SL. Urol Int 2001; 67: 257-263. | Sengoloa | E phatlalalitsoe |
18. Heaton JP, Dean J, Sleep DJ. Tsamaiso e latellanang e ntlafatsa phello ea apomorphine SL ho banna ba nang le bothata ba ho se sebetse hantle ha erectile. Int J Impot Res 2002; 14: 61-64. | Sengoloa |
19. Gerstenberg T, Hedlund H Ho: Graugaard C, Hertoft P, Møhl B (eds.). Hjerne & Seksualitet: Aspekter af Teori & klinik. Munksgaard, 1997