Neurophysiology ea Mosebetsi oa Erectile: Liphello tsa Androgenic
ARTHUR L. BURNETT
Tlaleho ea Andrology, Moq. 24, che. 90060, 2003
Tokelo ea molao © American Society of Andrology
Ho tsoa Lefapheng la Urology, James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland.
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Phekolo ea penile ke ts'ebetso e ikhethang ea vascular biologic e hlokang taolo. Har'a mekhoa ea taolo e kenyang taelo ena, tsamaiso ea methapo e nkoa e le mokhoa oa mantlha oa taolo o tsamaisang taolo ena. Methati e mengata ea neuroaxis, ho tloha bokong le mokokotlong ho ea ho methapo e felileng kahare ho penis, e qala le ho khutlisetsa litšusumetso tsa methapo e hlahisang karabelo ea erectile.
Ka nako e ts'oanang, hoa tsebahala hore androgens e fana ka likarolo tse hlahelletseng ntlafatsong le tlhokomelong ea li-circonal tsa assonal tse amehang tšebetsong ea monna ea thobalano. Boikarabello bona bo na le maemong a mantlha a tsamaiso ea methapo ea kutlo. Boithuto ba litla-morao tsa androgenic bo hlahlobile ka ho khetheha mekhoa e bohareng, ka ho shebisisa karohano ea botona le botšehali ea boko ba vertebrate. Mechine ea li-cellular e tlas'a taolo ea androgenic e kenyelletsa neurogeneis, phapang ea sele, phallo ea sele, phutuho ea "synapse", ho felisoa ha serethe le lefu la sele. Ho hatisoa ho eketsehileng ho fanoe haufinyane ho litlamorao tsa androgenic litseleng tsa peripheral neuronal. Tšoaetso ea litlamorao tsa androgenic ho li-neuron tsa peripheral e hlile e le liphetoho tsa sebopeho le tsa biochemical tse etsahalang haholo nakong ea bokhachane le kamora ho fallisoa, leha lipatlisiso tsa morao-rao li supile liphetoho tsa electrophysiologic har'a lits'oaetso tsena.
Tlhahiso ena e fana ka tlhahlobo ea nakoana ea taolo ea neural ea penile erection maemong a bohareng le a pherekano, ka tlhokomelo e ikhethang e fuoeng tšusumetso ea androgenic ho neuroanatomy, litseleng tsa neural, le methapo ea methapo e amehang karabong ea erectile. Ka hona, ho tla hlahlojoa hore na androgen e tla fana ka melao e nyelisang hakae tsamaisong ea taolo ea mantlha. Lintlha tse nkiloeng tlhahlobong ena li ka senola hore na ho kenella ha meriana le kalafo e sebelisang ts'ebetso ea methapo e sebelisang testosterone supplementation ho ka khoneha ho phekola ho se sebetse hantle ha erectile. Ho amoheloa hore boholo ba tsebo mabapi le taba ena bo tsoa liphuputsong tsa liphoofolo tsa mahlale, mme bopaki bo tobileng ba litlamorao tsa androgenic ho erection ea motho e lula e lekantsoe hantle. Ho feta moo, phapang ea 'nete ea litlamorao tsa androgenic e tsejoa ho ba teng lipakeng tsa liphoofolo tse tloaelo tse sebelisoang ka kotloloho, joalo ka phapano ea hore li-metabolites androgens tse sa tsitsitseng ha li na tšusumetso ea ho fifala ha thobalano ho li-primates (Cooke et al, 1998). Leha ho le joalo, leseli le hlahisitsoeng mona le fana ka monyetla oa ho nahana ka likarolo tsa taolo ea androgenic ea li-penile erection tsa methapo ea kutlo. Litekanyetso tse fokolang tse mabapi le ts'ebetso ea motho ea erectile li ka huloa hamolemo ka nako ena.
Mekhoa e Bohareng
Ho hlahisoa li-nuclei tse ngata tsa boko ho nka karolo taolong ea supraspinal ea li-penile erections (Burnett, 2000). Litsi tsa khokahanyo (ka tatellano e theohang ea neuroaxis) li kenyelletsa libaka tsa cortical le subcortical, diencephalon e nang le sebaka sa medial hypothalamic (nucleus paraventricular, sebaka sa medial preoptic [MPOA], le dorsal hypothalamic area), le boko ba methapo ( bona Tafole). Boemong ba mokokotlo oa mokokotlo, li-nuclei tsa bohlokoa li kenyelletsa kh'olomo ea sele ea lipakeng (eo ho thoeng ke karolo ea sacral parasympathetic maemong a lumbosacral), e laolang ho kenya letsoho ho noka; lenaka le bohareng la mokokotlo le mokokotlo oa boipheliso, joalo ka potoloho ea kutlo bakeng sa likhahla tsa mokokotlo; le mokokotlo oa Onuf (o tsejoang hape e le mokokotlo oa mokokotlo oa bulbocavernosus) o fumanehang lenakeng la ventral maemong a lumbosacral, a sitisang mesifa e amanang le penile. Bokong, nuclei ea diencephalon e kanna ea hokahana le maemo a mokokotlo a hokahanyang li-penile erections le libaka tse ling tse fapaneng tsa boko tse fanang ka maikutlo a ts'ebetsong ea tsona ea ho kopanya tlhaiso-leseling e nyolohang le e theohang. Mokokotlo oa mokokotlo o kopanya likonopo tsa neural reflexive lipakeng tsa penile afferents le matla a bobeli a boikemelo le a somatic a hlokehang bakeng sa likarabo tse hlakileng tsa erectile. Sisteme ea mantlha ea methapo ea kutlo e sebetsanang le boits'oaro e kenyelletsa mahlahana a fapaneng, a thehiloeng ka lithuto tse fapaneng tsa morphological le pharmacological ho liphoofolo. Likarolo tsa ho beha li teng bakeng sa monoamine (dopamine, norepinephrine, le 5-hydroxytrypatmine), li-amino acid tsa decarboxylated, neuropeptides (oxytocin, prolactin, adrenocorticotropin, opioids), le limolek'hule tsa gaseous.
Mechanisms ea Peripheral
Neuroregulation ea penile erection hangata e hloka ho hokahana ha mekhoa ea parasympathetic, kutloelo-bohloko, le somatosensory neural pathways (Burnett, 2000). Litsela tsena li hlalosa merero e sebetsang le e amanang. Morero oa phello e sebetsang o amanang le penile erection o bua ka thoracolumbar kutloelo-bohloko (T10-L2) le likaroloana tsa methapo ea tsamaiso ea methapo ea kutlo, le tsamaiso ea methapo ea methapo ea methapo (oblix somatic (S2-S4)). Ho kenya letsoho ho ikemetseng ho emeloa haholo-holo ke methapo ea pelo, e tsoang molemong oa hypogastric plexus e tlase, mme ho kenella ka mokhoa o itseng ho emeloa ke methapo ea kutlo ea pudendal, e tsoang mohopolong o phahameng oa kelello. Ts'ebetso e amanang le "penile erection" e kenyelletsa ho kenella hare ho motho (S2-S4) mme e emeloa ke methapo ea kutlo ea penis, makala a methapo ea methapo ea kutlo.
Ka kopanelo, litsela tsena tsa neural li laola tatellano ea phallo ea mali le ho kenella ka botoneng, hape li hokahanya tšebetso ea mesifa e amanang le penile e amanang le ho thatafala ha penile. Sebaka sa tšebetso se sebetsang kahare ho botona ke likarolo tse phetseng hantle tsa mesifa, vasculature e fanang ka penis, le trabeculae e nang le lithane tsa erectile tsa botoneng (Burnett, 2000). Likarolo tsena li arabela ho tšusumetso e nepahetseng ea neuronal ka ho hlahisa molumo oa mesifa o boreleli oa mesifa o susumetsang boemo ba boroko ba penis. Nakong ea penile tumescence le erection, penile vasculature vasodilates le trabecular tiske ea nchafala. Nakong ea tonic boemo ba bohlasoa, "vasculature" ea penile e thijoa kahare 'me linama tsa "trabecular" li kenelletsoe. Mehopolo ea hajoale e ts'ehetsa karolo ea mantlha ea nitric oxide, molek'hule oa gaseous, joalo ka mokena-lipakeng oa kemiso ea penile e sebeletsang e le neurotransmitter ebile e le sebopeho sa endothelial (Burnett, 2002), leha li-neurotransmitter tse ling li tsejoa ho susumetsa ts'ebetso ea methapo ea kutloano ea penile erection . Ho tataisoa ha mekhoa ea proerectile neurotransmitter le thibelo ea methapo ea methapo ea methapo ea methapo e sebetsa hammoho ho hlahisa erection e phahameng haholo.
Molao oa Androgenic
Mohopolo oa li-neurons tse mamelang li-steroid le mekhoa ea tsamaiso ea methapo e thehiloe hantle tsamaisong ea methapo e bohareng. Karolo e kholo ea ho ithuta e amana le ho fifala ka thobalano, e kopanyang tšusumetso ea li-hormone le libaka tsa boko tse laolang boitšoaro ba banna kapa ba basali. Androgens le estrogens li hlahisa litholoana ka libaka tse hlahisang li-steroid receptors tse laolang thepa ea methapo e fapaneng nakong ea ho hola le ho ba motho e moholo. Libaka tsena li emeloa ho tsoa tsamaisong eohle ea methapo ntle le ho kenella mohahong o le mong kapa setsing sa methapo.
Mohlomong sistimi e tsebahalang ka ho fetesisa ea "dimorphic" neuromuscular system ho liphoofolo tse anyesang e kenyelletsa lesapo la mokokotlo la mesifa ea bulbocavernosus (SNB). Leqhubu lena le hlalosa sehlopha sa li-motoneurons mokokotlong o ka tlase oa lumbar o kahare oa mokokotlo o kahare oa ischiocavernosus, bulbocavernosus le mesifa ea levator ani e khomaretseng botoneng. Rato e sebelitse e le mohlala oa phoofolo ea mantlha ho fuputsa khubu ena, e karolong e ka tlaase ea lenaka la ventral ka likarolo tsa lumbar 5 le 6 ho mofuta ona. Rats ea banna e na le bonyane makhetlo a 3 makhetlo a mangata a SNB joalo ka basali, 'me li-motoneuron tsena li boholo ba habeli ho ba batona ha li bapisoa le tsa basali (Breedlove le Arnold, 1980). Le ha litoeba tsa banna le tsa basali li na le lisele tsa SNB tse arohanang le mesifa ea bulbocavernosus pele a hlaha, mesifa le methapo e tsamaeang le eona ea tlhaho hangata e senyeha nakoana kamora ho hlaha ka likhoto tsa basali (Breedlove le Arnold, 1983). Ts'ebetso ena ea nts'etsopele e theha liphapang tsa batho ba baholo ba bong bo fapaneng ho SNB motoneurons le mesifa ea mesifa e lebisitsoeng. Mabaka a fapa-fapaneng a bopaki bo kenyelletsang ho pepeseha ha li-hormone le ho ikarola ka mokhoa o nepahetseng liphatseng tsa banna le basali ka lebaka la liphetoho tse fapaneng tsa morphological li matlafalitse tlhokomeliso ena (bakeng sa tlhahlobo e eketsehileng, bona Cooke et al, 1998).
Bopaki bo joalo ba liteko bo bontša ka ho hlakileng hore androgens e ama ho hokahana ha maikutlo a penile a amanang le SNB. Mokhoa oa tsamaiso ee ke oa mofuta ofe? Lithuto tsa nts'etsopele li rata khopolo-taba eo li-motoneurons tsa SNB li e bolokileng tlas'a tšusumetso ea androgens li boloka mesifa ea sepheo, ka hona e baka ho bolokoa ha li-innervation tsohle tse amanang (Breedlove le Arnold, 1983). Lintho tsa Neurotrophic ho nahanoa hore li laoloa kapa li susumetsoa ke androgens ho boloka mesifa le li-motoneurons tse amanang le tsona (Forger et al, 1995; Al-Shamma le Arnold, 1997). Tšusumetso ea androgenic e boetse e lumelloa ho fana ka karolo ea tlhokomelo ea ho ba motho e moholo (rand le Breedlove, 1995; Nanasaki le Sakuma, 2000). Motheo oa litlamorao tsa trophic botsofaling ha o amane feela le ts'ehetso ea androgenic ea mesifa e amanang le penile. Boemong bona ba ntlafatso ea mmele, li-motoneurons tsa SNB li boetse li ntlafalitse ho hlahisa li-androgenic receptors hoo li ka sebetsang ka kotloloho ho pepesoa ha androgen ho boloka boholo ba somata (Freeman et al, 1996).
Mohlomong setsi sa thuto ea tlhaho se tebileng ka ho fetisisa sa thuto ea botona le botšehali ke MPOA, e nang le tlhaiso-leseling e tsoang mefuteng e fapaneng ea liphoofolo, ho kenyeletsoa batho. Ka har'a khubu ena, sehlopha sa li-neuron se nang le botona bo bong se khethollotsoe mefuta eohle e fapaneng, 'me ka litoeba li lekana le linako tsa 5 ka bongata ho ba batona ho feta ho basali (Gorski et al, 1980). Moralo oa tšebetso ea li-neurons tsena o boetse o fapane pakeng tsa batšehali ka litoeba, mabapi le masimo le khokahano (Raisman le Field, 1973). Liphuputso tse tlamang li-receptor li entse libaka tsa marang-rang tse nang le li-steroid ho li-neuron tsena tse ikhethang, ka libaka tse ngata tse tlamang li-estrogen receptor litlelong tsa basali ho feta ho likhoto tsa banna le boemo bo hloahloa ba li-androgen receptor-binding litlelong tsa banna ho feta ho likhoto tsa basali (Jacobson et al, 1987). Leha ho le joalo, ts'ebetso ea setsi sena sa tlhaho sa "dimorphic neural" ho limmary e lula e sa tsejoe, ka datha tse lekanang esita le maemong a pente: kamora ho lisa sebaka, ha ho na liphetoho lipapatsong tsa banna ho litoeba, athe ho fokotseha hoa mekhoa ena ho fella ka kokoana-hloko ( Cooke et al, 1998).
Taolo ea androgenic ea li-neurons tsa bongoana tsa dimedia tsa "sexor" e latela mekhoa ea "organical" ntshetsopele le "aromatization hypotheses" lithutong tsa rat. Tšusumetso ea humors ho neurogeneis le ho hola ha neuronal bophelong ba bongoana le kamora ho pepa ho bolela litlamorao tsa nts'etsopele (Gorski et al, 1980). Liphetoho ponts'o ea gonadal steroid botsofaling ha e ame morphology ea nucleus ena (Gorski et al, 1980). Leha ho le joalo, phetisetso ea testosterone ea nako e telele ho litheko tse tsofetseng e bonts'itsoe ho boloka boits'oaro bo ntseng bo eketseha hammoho le ts'ebetso ea dopaminergic ho MPOA (Sato et al, 1998), e fana ka maikutlo a hore bonyane ho pepesetsoa ha androgenic ho ka ba le litlamorao ho ba motho e moholo ho feta boemo ba morphological . Ho khahlisang ke hore kalafo ea estrogen e atleha haholo ho fetoloa hoa mofuta ona oa "li-neuron" ho feta kalafo ea androgen ho likhoto, ho bontša hore li-metabolites tsa androgen tse lekaneng li tiisa hantle li-neuron tsena (Dohler et al, 1984).
Li-nuclei tse ling tsa "sex dimorphic" tse bohareng le tsona li hlalositsoe haholo ka mabaka a morphological mme haholo-holo ka mefuta ea litoeba. Tsena li kenyelletsa tsamaiso ea li-limbic olicory (medial amygdala, khubu ea boroko ea stria terminalis, sebaka sa preoptic), hippocampus, le assort hypothalamic nuclei.
Kopano ea li-androgens le ts'ebetso ea li-neurons tsa peripheral autonomic li sa tsoa ithuta. Li-receptors tsa Androgen le kutloisiso ea androgenic li bontšitsoe bakeng sa lumbosacral preganglionic neurons, kutloelo-bohloko le parasympathetic postganglionic neurons, le sensory postganglionic neurons (Schirar et al, 1997b). Ho bontšoa thahasello e kholo ho lisele tsa autonomic ganglion ganglion ganglion, e nang le motsoako oa li-neurons tse nang le kutloelo-bohloko le parasympathetic. Ho litoeba, li-neurons tse nang le kutloelo-bohloko li fetoha ka boholo bo tšoaeang haholo kamora ho tsamaisoa kapa tsamaiso ea testosterone (Keast and Saunders, 1998). Tumellanong le tlhokomeliso ena, ho pepesoa ha testosterone ho amana ka kotloloho le bokhoni ba membrane ba kutloelo-bohloko ba neurons ho pelvic ganglia ea likhoto (Kanjhan et al, 2003). Le hoja bopaki bo fana ka maikutlo a hore androgens ka ho khetheha e susumetsa kholo ea mmele oa lisele tsa neuronal le boholo, bopaki bo eketsehileng bo supa phello ea bona mekhoeng ea ion le litseleng tsa bobeli tsa len messengerosa tse amanang le methapo ea kutlo ea pelvic ganglion. Mohlala, ho litoeba, ho tsamaisoa hoa sephetho sa methapo ea methapo ea kutlo ea nitric oxide synthase, e hlahisang nitric oxide neuronally, athe testosterone e khutlisitsoeng kamora ho fallisoa e khutlisa boemo bona ba methapo (Schirar et al, 1997a). Ho ile ha bontšoa litlamorao tse tšoanang bakeng sa ho felisoa hoa methapo ea kutlo ea lapvasous le dorsal nerve penis penis (Giuliano et al, 1993; Baba et al, 2000).
Phetoho ea botho
Litsela tse ngata tsa bopaki ba liteko li hlahisa karolo e kholo ea lihormone tsa steroid karohanong ea thobalano ea tsamaiso ea neural ho liphoofolo. Ntle le bopaki ba morphological, litsi tsa tlhaho tsa thobalano tsa nama tsa thobalano li hlahisa litšebelisano tse ntle ho batho joang? Taba e hlakileng ntlheng ena ke hore ho thata ho khetholla bokong ba motho e moholo hore na ho potoloha gonadal steroids account bakeng sa pono e amanang le thobalano e sa amaneng le ketso ea pelehi ea fetal. Ntle le moo, liphapang tsa sebopeho tsa tlhekefetso ka thobalano li ka hlalosoa motheong oa boiphihlelo ba motho, ekaba nakong ea kholo kapa kholo, hape ntle le kamano ea bongoana. Ho rarolla mathata a joalo ho ka fihlelleha haeba litšoantšo tsa botona le botšehali li hlakile ka nako ea tlhaho, leha mehlala e fokolang e teng ho ts'ehetsa khang ena. Kameho ea hore boima ba kelello ba motho e kholo ho ba batona, ka mohlala, e ka amahanngoa le phello ea androgens ka tokollo le ts'ebetso ea lintlha tse ling tse kang kholo ea kholo ntle le ketso e tobileng ea li-steroid. Ka mokhoa o makatsang, liphapang tse ngata tsa botona le botšehali ho batho li ka hlahella ka lebaka la ho pepesetsoa ha androgen ka nako e itseng ea bohlokoa kamora ho pepa. Bopaki ho batho ha bo khethollehe ho fana ka polelo ea hore na ho pepesetsoa li-hormone tsa fetus ho khetholla boitšoaro bo bobe ba ho kopanela liphate. Ha ho na bopaki ba ho tšehetsa tšusumetso ea batho ba bang ka batho ba bang, mme mohlala oa androgen-insensitive XY motho ea sa bontsheng boits'oaro ba masculine leha e le kantle ho basali ka sebele o tla hanyetsa mohopolo ona. Ka hona, bopaki bo hlakileng ba hore li-steroid tse sebetsang pejana nts'etsopele ka kotloloho li tiisa masculinize boko ba motho bo ntse bo haella.
Ka hona, motheong oa bopaki ba liteko mabapi le taba ena, liqeto mabapi le taolo ea androgenic holim'a neuroregulation ea erection ea motho li lokela ho thibeloa. Ka lehlakoreng le leng, hobane ho bonahala ka kotloloho hore li-androgens li susumetsa boitšoaro ba banna ba botona le botšehali, ho sa ntse ho na le thahasello e hlakileng ea ho hlahloba hore na lihormone tsa steroid li laola kelello ea motho ea moholo joang hona kae. Bopaki bo emelang litlamorao tsa androgenic ho li-neuroregulation tsa erection ho batho bo fanoa ke data ea kliniki e bonts'ang bohlokoa ba androgens ho li-erections tse lekiloeng nakong ea tlhahlobo ea penile tumescence ea bosiu ka laboratoring ea boroko (Cunningham et al, 1990). Kutloisiso ea hona joale ke hore li-erections tse amanang le boroko li kenyelletsa ts'ebetso ea matla a taolo ea supraspinal e sebetsang nakong ea boroko bo potlakisang mahlo (Lue, 2002). Pholoso ea li-erections tse amanang le boroko ka tekanyo e kholo ho banna ba nang le eugonadism ho feta ho banna ba nang le hypogonadism e fana ka maikutlo a matla a androgenic moduction ea mochini ona. Leha ho le joalo, liponahatso tse ling tsa erection neurophysiology, joalo ka likarabo ho khothatso ea botona kapa ea thobalano ea thobalano, li kanna tsa se sebetse tlasa taolo e totobetseng ea androgenic. Ehlile, banna ba nang le hypogonadism ba ka fihlela li-erections ho lumella liketso tsa thobalano, mme banna ba nang le eugonadism ba ka ba le bothata ba ho fihlela li-erections tsa ho etsa thobalano. Lintho tse fapaneng tsa taolo li kanna tsa ameha tlasa maemo ana a fapaneng 'me tsa fana ka likarolo tse ngata ho sa tsotelehe hore na ts'ehetso ea androgenic e kae.
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