Ho se sebetse hantle ka mokhoa oa Erectile: Tlhahlobo ea Likhetho tse Phethahetseng tsa Phekolo bakeng sa Phello e Ntle (2019)

Source: Tlaleho ea Phekolo ea Puseletso, Buka ea 8, Palo 1, 16 Hlakubele 2019

Author: Rezler, Kathryn

HO HLOKA

Erectile dysfunction (ED) e tloaelehile le botsofali. Pejana kalafo ea ED e ne e fanoa haholo ke litsebi tsa ur ur, empa tumello le ts'ebeliso e pharaletseng ea li-inhibitors tsa phosphodiesterase li nolofalelitse baoki ba tlhokomelo ea mantlha ho fana ka kalafo e lebisitsoeng ea ED. Leha liteko tse kholo tsa bongaka bo bongata li bonts'itse ts'ebetso le polokeho ka lithethefatsi tsena, ha li sebetse ho 30- 35% ea banna, li ka baka litlamorao, mme ha li ntlafatse methapo ea kutlo. Kutloisiso e phethahetseng ea 'mele ea erectile le lisosa tsa ED le moralo o felletseng oa kalafo o sebetsanang le lintlha tsohle tse kenyang letsoho o ka sebetsa hantle ho feta taolo ea meriana mme o ka ntlafatsa likarolo tsa bophelo bo botle ba kelello le ba' mele ntle le mathata a erectile.

SELELEKELA

Erectile dysfunction (ED) - ho se khone ho theha le ho boloka feme e nang le bokhoni ba ho kenella - e tloaelehile le botsofaling. Hoo e ka bang 40% ea banna ba lilemo li 40 le 70% ea banna ba lilemo tse 70 ba na le mofuta o itseng oa ED.1 ED e amahanngoa le maemo a mangata a 'mele, e kanna ea ba harbinger ea lefu la metabolic kapa vascular, mme e ama bophelo bo botle ba kelello. Phosphodiesterase mofuta oa 5 inhibitors (PDE5i) ke kalafo ea pele e tloaelehileng ka ho fetisisa bakeng sa ED. Liteko tsa tleliniking tse kholo, tse nang le mefuta e mengata li bonts'a katleho le polokeho ea lithethefatsi tsena; leha ho le joalo, ha li sebetse ho 30-35% ea bakuli,2 e kanna ea baka litlamorao, 'me ha e ntlafatse methapo ea kutlo. Phekolo e phethahetseng bakeng sa ED e shebang lintlha tsohle tse kenyang letsoho e ka ba e sebetsang ho feta taolo ea meriana ebile e ka ntlafatsa likarolo tsa bophelo bo botle ba kelello le ba 'mele ntle le mathata a erectile.

TLHOKOMELISO EA ANATOMY LE PHYSIOLOGY OF ERECTIONS

ED e hlaha manonyeletsong a mangata, a rarahaneng a amanang le methapo ea methapo, ea methapo ea kutlo le ea endocrine. Tlhahlobo ea mantlha ea anatomy le physiology ea li-erections e tla fana ka moralo oa ho utloisisa pathophysiology le rationale bakeng sa likhetho tsa kalafo (Setšoantšo sa 1). Karolo ea penis e na le meqomo e 'meli ea methapo ea methapo (Corpora cavernosa) e tsamaisang bolelele ba moqomo oa penile hammoho le Corpus spongiosum e potolohileng urethra. Lithane tsa penile li hlalosoa ka likarolo tsa autonomic (kutloelo-bohloko le parasympathetic) le likarolo tse ling tsa (sensory and motor) tsa tsamaiso ea methapo ea kutlo. Manonyeletso a kutlo a hlaha ho T11-L2 'me a anti-erectile, a laolang ejaculation le detumescence. Litla-morao tsa Parasympathetic li hlaha ho S2-S4 'me li pro-erectile. Li-nerve tse utloisang bohloko le tse harelanang li kopana ho theha methapo ea kutlo e kenang kahare ea coora, "corpus spongiosum" le "glans penis", e laolang phallo ea mali nakong ea kemaro. Leqhubu la pudendal le fana ka maikutlo ho sefahleho sohle sa pelvis le sa motor ho li-sphincters tsohle, mokokotlo oa pelvic le mesifa e thata.

Anatomy ea botoneng e bonts'a likarolo tse kholo, methapo ea mali le methapo.

Setšoantšo sa 1:

Anatomy ea botoneng e bonts'a likarolo tse kholo, methapo ea mali le methapo.

Methapo e ka hare ea pudendal e fana ka phallo ea mali ho ea botoneng, e kenella ka har'a methapo ea methapo ea methapo le methapo. Artery ea bulbourethral e feta har'a penile e tebileng (Buck) fascia, e fana ka bulb ea penis le penile urethra. Motsoako oa dorsal o tsamaea pakeng tsa methapo ea methapo ea mokokotlo le methapo e tebileng ea methapo e fana ka makala a potileng a tsamaeang le methapo ea methapo-kholo le makala a emeng. Ho kenella hare ho "penile" kapa "venvernosal" ho kena ka har'a corpus cavernosum, 'me ho tsamaisa bolelele ba moqomo oa penile, ho fana ka methapo e khethehileng ea methapo ea letsoho.

Ho tsosa takatso ea botona kapa ea botšehali ho tsosa methapo ea kutlo ea parasympathetic ho lokolla acetylcholine. Ka hare ho lisele tsa endothelial liling arter penter artery, nitric oxide synthase (NOS) e thusa ho hlahisa oxidation ea L-arginine ho nitric oxide (NO) le L-citrulline. HA HO na ts'ebetso ea "cycase" ea cyanyase ho cosora cavernosa le spongiosum, eo ka nako eo e eketsang cyclic guanosine monophosphate (cGMP) e lebisang phomolong ea mesifa e boreleli, vasodilation, le phallo ea mali e eketsehang. Ho tlatsa ka potlako le ho hola ha ts'ebetso ea sinusoidal ho baka ho ts'oaroa ha mali ka litšelo tsa venous plexuse le tunica albuginea, e hlahisang hoo e ka bang palo e felletseng ea phallo ea venous. Khatello ea Intracavernosal e fihla 100 mmHg ka botlalo bo phethahetseng. Mesifa ea Ischiocavernous e hatella cavernosa e tlatsitsoeng ke mali joalo ka konteraka ea mesifa ea mesifa e bakang khatello ea ho qetela ea ho fihla ho milHg tse makholo a 'maloa. Kamora ho emisoa, nko ea neurotransmitter e khaotsa ka lebaka la kutloelo-bohloko ea methapo ea kutlo le phosphodiesterase enjene e senya cGMP e lebisang ho senyeng le ho fufuleloa (Setšoantšo sa 2).

Physiology ea li-erections.

Setšoantšo sa 2:

Physiology ea li-erections.

Ach, acetylcholine; cGMP, cyclic guanosine monophosphate; TSOHLE, nitric oxide; PDE, phosphodiesterase; SNS, tsamaiso ea methapo e nang le kutloelo-bohloko.

HO FIHLELA FINYELETSO EA PELE

Tlhahlobo e phethahetseng ea ED e hloka nalane e phethahetseng, tšebeliso ea lipotso tse netefalitsoeng, tlhahlobo ea 'mele le mosebetsi oa lab. Ho etsisa, joalo ka duplex doppler ultrasound, penile arteriography, le MRI e lokela ho etsoa ke urologist mme e boloketsoe ts'ebetso e ka ba teng ea ho buoa.

PELE

Ho nka nalane e felletseng ho fana ka monyetla oa ho khetholla lisosa tsohle / mabaka a tlatselletsang a amanang le ED. Mabapi le mabaka a kelello, ho botsa ka khatello ea hona joale le mathata a kamano ho bohlokoa.

Litabatabelo tsa setho sa botona le botšehali khafetsa tsa thobalano hangata li hlokomolohuoa lihlooho ha li nka nalane ea thobalano, empa li ama ts'ebetso ea thobalano haholo. Liphetho tse tsoang ho nts'etsopele le ho netefatsoa ha Male Genital Self-Image Scale (MGSIS) tse ileng tsa lekola banna ba lilemo tse 18-60 li fumane hore banna ba nang le litšoantšo tsa botona tse ntlafalitsoeng ba tlalehiloe ba le tlase ho ED le 20% ea banna ba sa khotsofalang ka boholo ba botona ba bona ba botona.3 Banna ba nang le litšoantšo tse litšila tsa botona kapa botšehali ba ka ipotsa hore na boholo ba botona ba bona bo bapisoa le banna ba bang joang. Lintlha tsa Alfred Kinsey ho banna ba 2500 li tlalehile bolelele bo boholo ba botoneng bo boholo ba lisenthimithara tse 1 le penis e kholo e lekanang le lisenthimithara tse 4-5. Ho khahlisang, banna ba tloaetse ho nyenyefatsa boholo ba botona ba bona ba botona bo bapisoa le tekanyo ea 'nete.4

Ho buisana ka tebello mabapi le khafetsa ea thobalano ho bohlokoa ho banna ba nang le libido tse tlase, maikutlo a ho ikhalala, kapa ho ba le bohelehele ka khafetsa ea bona ea thobalano ha ba bapisoa le banna ba bang. Lipalo mabapi le khafetsa ea likamano tsa thobalano li lekanyelitsoe. Tlhahlobo e le 'ngoe ea AARP ea banna le basali ba 1670 ba ka holimo ho lilemo tse 45 e tlalehile hore 41% ea banna ba lilemong tsa bona tsa 50, 24% ea banna ba lilemong tsa bona tsa 60, le 15% ea banna ba lilemong tsa bona tsa 70 ba etsa thobalano bonyane hang ka beke (ho ngoloa hape ka lipalo-palo tsena. - 59% ea banna ba lilemong tsa bona tsa bo-50, ba mashome a mabeli a metso e robeli ho tse 76 lilemong tsa bona, mme 60% ea banna ba lilemong tsa bona tsa 85 ba etsa thobalano hangata ho feta hanngoe ka beke.5 Mokhatlo oa Machaba oa Bongaka oa Thobalano (ISSM), o tlaleha sephetho ho tsoa ho Setsi sa Naha sa Thupelo ea Naha ea Kinsey sa 2010 sa Bophelo bo Botle le Boitšoaro, o hlokometse hore tlasa halofo ea banna ba nyetseng ba lilemo li 25- 49 ba ne ba etsa thobalano makhetlo a 'maloa ka khoeli ho isa bekeng. tekanyo e phahameng ka ho fetisisa mokhatlong ofe kapa ofe oa lilemo.6 Phuputso e 'ngoe e phatlalalitsoeng ke ISSM e mabapi le banna le basali ba kaholimo ho lilemo tse 50 e tlalehile hore ke banna le basali ba 20-30% feela ba lulang ba etsa thobalano ho isa lilemong tsa bona tsa bo-80.7

Tšebeliso ea litšoantšo tsa bootsoa ke taba eo ho ka bang thata hore lingaka li buisane le bakuli ba tsona ba banna. Leha ho fumanoe ts'oaetso ea ts'ebeliso ea lits'oants'o tsa litšoantšo tsa bootsoa, ​​ho na le bopaki bo ntseng bo eketseha bo hokahanyang tšebeliso ea litšoantšo tsa bootsoa khafetsa ka tšusumetso ea khotsofalo e kopaneng ea thobalano, thabo lenyalong le ho hloka thobalano ka thobalano ho kenyeletsa libido e tlase le ED.8-11 Litšoantšo tse manyala tse hlephisang boitšoaro tsa inthanete li fana ka lipale tse se nang moeli tsa video le mofuta oa video e batlang e ka tsosang takatso ea botona kapa ea botšehali, e thatafalletsang banna ho fetolela balekane ba bophelo ba nnete.12 Ha ho na sesebelisoa se netefalitsoeng sa ho tsebahatsa mathata a amanang le litšoantšo tsa bootsoa ho kenyeletsa le ED se hlahisitsoeng. Kamora ho botsa ka khafetsa ts'ebeliso ea litšoantšo tsa bootsoa, ​​bafani ba tsa bophelo bo botle ba lokela ho botsa ka bokhoni ba ho fihlela le ho boloka sekhahla nakong ea thobalano e kopaneng le ho ipholla litho ntle le tšebeliso ea litšoantšo tsa bootsoa kapa ho li hopola. Haeba ho sebelisa kapa ho hopola litšoantšo tse litšila tse tsosang takatso ho hlokahala hore ho hlahisoe mohopolo o lekaneng, ho hlahisang litšoantšo tse litšila tse tsosang takatso tsa bootsoa ho ka ba le bothata.

LIPOTSO TSE BOTSOANG

Lintlha tsa lipotso tse netefalitsoeng li thusa ho hlahlobisisa ED. Potso e sebelisoang haholo tlhahlobisong ea bongaka le liphuputsong tse phatlalalitsoeng ke 15-element International Index of Erectile Function (IIEF-15), e netefalitsoeng ka lipuo tse 32.13 Mofuta o khuts'oanyane, lipotso tsa IIEF-5, kapa lipotso tsa thobalano tsa Health Health Inventory for Men (SHIM) le tsona li ka ba molemo ho tlhahlobisong le ho lekola ts'ebetso ea kalafo.14,15

TLHALOSO MOTSOALI

Tlhahlobo ea 'mele e lokela ho kenyelletsa tlhahlobo ea penile le testicular, mohlomong le matla a mesifa ea pelvic floor (ka tlhahlobo ea dijithale), khatello ea mali, bopaki ba lefu le pelo, bophahamo, boima, le sekhahla sa letheka.

MOSEBETSI

Ho ipapisitsoe le nalane le tlhahlobo ea 'mele, tlhahlobo ea laboratori e kanna ea kenyelletsa "metabolism" e phethahetseng le lipid, "insulin" e potlakileng le hemoglobin A1C .

LITLHAKISO LE LITLHAKISO TSE KHOLO

Lisosa le mabaka a tlatsetsang ho ED a ka feta. Tsena li kenyelletsa litaba tsa kelello, mathata a methapo, tšebeliso e feteletseng ea litšoantšo tsa bootsoa, ​​mathata a endocrine, litla-morao tsa meriana le liphetoho tsa methapo.

KELELLO

Matšoenyeho a bohlokoa, mathata a kamano, khatello ea maikutlo, ho tšoenyeha le khatello ea maikutlo ea morao-rao tse ka sithabetsang kaofela li ka kenya letsoho ho ED. Matšoenyeho a ts'ebetso, a hlalositsoeng pele ke Masters le Johnson ka 1970,16 ke ho sitoa ho fihlela mohopolo ka lebaka la liphihlelo tsa nakong e fetileng le ED. Ho se sebetse hantle ka thobalano, haholo-holo ED le ho fokotseha ha takatso ea thobalano, ho eketsoa haholo ho batseteli ba banna ba nang le khatello ea maikutlo ea morao-rao.17 Psychogenic ED hangata e hlaha nakong ea thobalano e kopaneng le tšebetso e tloaelehileng ea erectile nakong ea thobalano. Ho qala ho ka fetoha ka tšohanyetso, ho tsamaisana le khatello ea maikutlo e kang ho felloa ke mosebetsi, ho shoeloa ke mong ka uena kapa mathata a lichelete. Litokisetso tsa mantsiboea kapa li-erections tsa hoseng hangata li tloaelehile.

NEUROLOGICAL

Tsamaiso ea maoto le matsoho, ho kenyelletsa le amygdala; hippocampus; le dentate le cingulate gyri, ke se seng sa libaka tsa khale ka ho fetisisa tsa boroko tse tloaelehileng ho liphoofolo tsohle tse anyesang. Sebaka sena sa boko se laola maikutlo le liteko tsa ho qoba bohloko le ho batla menyaka. Patlisiso e fana ka maikutlo a hore takatso e bonoang ea thobalano e susumetsa Amygdala le hypothalamus haholo ho banna ho feta basali.18 Kenyelletso e tsoang ho amygdala e etela sebakeng sa ventral striatum, karolo e kholo ea basal ganglia e sebetsang e le karolo ea tsamaiso ea moputso. Li-bokellase tsa "nucleus" tse kahare ho "ventral striatum" li na le mokokotlo o moholo oa li-dopaminergic neurons 'me li nkoe e le setsi sa thabo sa boko. Ho supa ka dopamine ho bapala karolo ea mantlha molemong oa ho tsosa takatso ea thobalano le maikutlo. Ho kenngwa tshebetsong ha dopamine receptors ho lumbosacral parasympathetic nerves ea lesapo la mokokotlo ho thusa li-erections.19

Maemo a sitisang dopamine ho saena kapa ho se sebetse hantle ka methapo, kapa a ka senyang tsamaiso ea methapo e kholo, mohlala, lefu la Parkinson, multiple sclerosis, lefu la tsoekere, kapa stroke, le tsona li ka baka ED. Ho lemala ha methapo ea kutlo ea Cavernous nakong ea radatitis ea radical ho lebisa ho ED ho banna ba fetang 50%.20 Ho palama maeto a malelele ho ka hatella methapo ea mali ea pudendal le methapo ea mali pakeng tsa lesapo la mokokotlo le la pelo, ho fokotsa phallo ea mali le oksijene ho ea botoneng.21,22 Bo-cyclist ba ka ba le ho ba le letsoalo la nakoana la setho sa botona le botšehali; leha ho le joalo, ba kanna ba se be le kotsi e kholo ho ED. Liphetho tsa boithuto ba morao-rao ba banna ba 5000 ba baatlelete li bontšitse hore baesekele ba ka ba le monyetla oa ho etsahalloa ke ED joaloka basomi le limathi.23

SEBELISO PORNOGRAPHY

Le ha tšebeliso ea litšoantšo tsa bootsoa e ka nkuoa e le e amohelehang sechabeng le e tloaelehileng, likotsi tsa bophelo bo botle ba tšebeliso ea khafetsa ha li tsejoe. Litšoantšo tsa bootsoa tsa inthanete li fana ka pono e sa lekanyetsoang ea mohlala oa Bigidge Athlet, e leng ntho ea tlhaho e bonoang ho liphoofolo tse tona ha li bontša thahasello e nchafalitsoeng haeba e hlahisoa le balekane ba fapaneng ba amohelang thobalano.24 Sena se fana ka monyetla oa ho iphetola ha lintho ho nolofalletsang monna ho emolisa tse ngata tse tšehali. Tlhahiso ea nalane ea thobalano e tsosa takatso e matla le e matla ea ho kopanela liphate, 'me e potlakisa ho tsoaloa hangata ka peō ea botona le tlhahiso ea peō ea botona.25-27

Tšebeliso e feteletseng ea litšoantšo tsa bootsoa tsa inthanete e ka susumetsa neuroplasticity.28 Lithethefatsi tsohle tsa tlhekefetso le bokhoba ba boitshwaro, joalo ka papali ea inthanete le tšebeliso e ngata ea lijo, li ama tsela ea mesolimbic dopamine tseleng le li-nucleus accumbens.29 Novelty e phahamisa lits'oaetso tsa dopamine ka har'a li-nucleus accumbens, e leng se etsang hore ho lokolloe protheine ea cAMP e sebetsang (CREB). CREB e laola mofuta oa tlhahiso ea dynorphin, protheine e liehisang ho lokolloa ha dopamine, e fokolisa tsamaiso ea moputso.30 Ho lumeloa hore ona ke motheo oa mamello ha ho hlokahala hore lithethefatsi kapa boits'oaro bo ntseng bo eketseha ho hlola CREB e ngata. Ha e sa thibeloe, ho fokotsa dopamine ho phahamisa anhedonia, ho ka ipehela ts'ehetso ea lithethefatsi kapa boits'oaro.

Ntle le CREB, DeltaFosB e lokolloa ka meroallo e mengata ea dopamine ea li-nucleus tse bokellitsoeng. DeltaFosB e khothalletsa ntlafatso e ntle ea boitšoaro ba bokhoba ka ho hatella ho lokolloa ha dynorphin le ho eketsa kutloisiso ea lithethefatsi kapa boits'oaro. DeltaFosB e phehella nako e telele, e lebisa litsebi tse ling tsa bokhoba ba tahi ho e bitsa "phetoho ea limolek'hule tsa ho lemalla."31 Mochine ona o hlalosa kamoo tšebeliso ea litšoantšo tsa bootsoa khafetsa, joalo ka lintho tse ling tse lemalloang, e etsang hore takatso le litheko tsa dopamine li hlahe, e behe mosebelisi letšollo la ho loana, ho lakatsa, le khoholeho ea matla.32

PUSELETSO

Ntle le hore ho hlokahala bakeng sa nts'etsopele le kholo ea botoneng le ho ntlafatsa khokahano ea thobalano, testosterone e laola physology ea erectile ka methati e mengata. Testosterone e matlafatsa sebopeho sa methapo e nepahetseng, bots'epehi le ts'ebetso, haholo-holo methapo ea kutlo.33 Liphuputso tsa liphoofolo le tsa batho li bontša hore testosterone e ntlafatsa mofuta oa nitric oxide synthase gene le tlhahiso ea NO maemong a methapo ea methapo, e hlokahalang bakeng sa vasodilation.34,35 Testosterone e kanna ea fetola tšebetso ea PDE5 joalo ka ha ho netefalitsoe ke lithuto tsa liphoofolo tse bonts'ang tlhahiso-taelo ea polelo ea PDE5 ka tlatsetso ea testosterone.36,37

Maemo a tlase a testosterone ea mahala le ea bioavava (empa eseng e felletseng) e amahanngoa le ho se sebetse ha erectile.38 Leha boemo ba testosterone bo hlokahalang ho fihlela le ho boloka li-erections ha bo tsejoe, palo e fokolang e bonahala e hlokahala bakeng sa ts'ebetso ea erectile.39,40 Tlatsetso ea testosterone e kanna ea se ke ea ntlafatsa ED ho banna bohle; leha ho le joalo, lithuto tse ling li bontšitse hore phekolo ea testosterone e ka ba molemo mme ea nolofalletsa li-inhibitors tsa PDE-5 hore li sebetse betere.41,42

Bangoli ba bang ba ngotse litekanyetso tse phahameng tsa estradiol ho banna kapa tekanyo e phahameng ea estradiol-to-testosterone e amanang le ED.43-45 Aromatase inhibitors e thibela phetolo ea testosterone ho estradiol mme e ka eketsa testosterone e felletseng le ea bioava ho banna ba tsofetseng ba nang le hypogonadism e bonolo ha ba ntse ba theola maemo a estradiol hanyane.46 Hajoale ha ho na bopaki ba hore aromatase inhibition e ntlafatsa ts'ebetso ea thobalano mme ha ho lingoliloeng tse tšehetsang ts'ebeliso ea aromatase inhibitors bakeng sa hypogonadism.47 Ntle le moo, liphuputso tse ling li fumane karolelano pakeng tsa estradiol le testosterone e sa amaneng le ts'ebetso ea erectile kapa takatso ea thobalano.48,49

Secretion e phahameng ea prolactin ke sesosa se sa tloaelehang sa testosterone e tlase le ED. Sena se ka bakoa ke tumello ea pituitary (prolactinoma), matekoane, kapa meriana e joalo ka amphetamines, H2 blockers, risperidone, SSRIs, MAO inhibitors, le li-antidepressants tse ling tsa triceclic. Prolactin e lokela ho lekanngoa feela maemong a takatso e tlase ea thobalano, gynecomastia, le / kapa maemo a testosterone a felletseng ka tlase ho 4 ng / mL (400 ng / dL).50

Ka bobeli hypothyroidism le hyperthyroidism li ka lebisa ho ED mme ED e atile haholo ho banna ba nang le dysthyroidism ho feta litulong.51 Phekolo ea hypothyroidism le hyperthyroidism e ka ntlafatsa ED.52 Ka hona, ho khothalletsoa ho hlahlojoa ha dysfunction ea qoqotho ho banna ba hlahisang le ED e khothalletsoa.

MOLETSANE

Bophelo bo botle ba vascular bo bohlokoa ho fihlella le ho boloka li-erections. Ho hloka taolo ea methapo ho baka 70-80% ea bao e seng psychogenic ED ho banna ba baholo. Hobane atherosulinosis ea methapo ea mokokotlo, carotid, cerebral, kapa peripheral artery e ka baka matšoao feela ha e tsoetse pele, ED e ka ba lets'oao la pele la lefu le akaretsang la vascular.53,54 Teko ea Prostate Cancer le Prevention, banna ba ka bang 10,000 1994 ba khethiloeng ka letsoho la placebo ba ile ba hlahlojoa likhoeli tse ling le tse ling tse tharo mme ba lateloa bakeng sa lefu la pelo le pelo ho tloha 2003 ho fihlela XNUMX. ED e ne e le sesosa se seholo sa liketsahalo tsa kamoso tse amanang le pelo le ho tsuba le nalane ea lelapa ea lefu la pelo.55 Ho ba teng ha ED e kanna ea ba ponelo-pele ea lefu le bakang lefu lohle.56 ED e arolelana mabaka a tšoanang a kotsi le lefu la pelo - khatello e phahameng ea mali, ho se ikoetlise, ho ja hantle, ho tsuba, lefu la tsoekere, le hyperlipidemia. Mochini o ka sehloohong oa li-ED tse amanang le vassa o kenyelletsa ho se sebetse hantle ha mmele.57,58 Taolo ea vasodilation ke ts'ebetso ea nitric oxide (NO) e hlahisitsoeng ke lisele tsa endothelial. HA HO na motho ea qalang tlhahiso ea cGMP e bakang ho phomola ha mesifa le ho opeloa ha methapo ea methapo ka har'a corpus cavernosum. Ho hloka taolo ea endothelial ho eketsa kotsi ea ED, ho sa natsoe bopaki ba kliniki ea lefu la pelo le pelo.59,60

LITLHAKISO TSA MAHALA

Lisebelisoa tse ngata tsa meriana li ka kenya letsoho ho ED ka ho ama li-neurotransmitters, lihormone, ts'ebetso ea methapo, kapa phallo ea mali. Le ha e se lenane le tlatselletsang, lisosa tse tloaelehileng li kenyelletsa li-antidepressants (haholo-holo li-SSRI tse kang fluoxetine, sertraline, citalopram), anxiolytics, CNS depressants, le mesifa ea ho phomola (lorazepam, cyclobenzaprine). Diuretics (HCTZ, spironolactone, triamterene, furosemide) le li-antihypertensives le beta-blockers (clonidine, enalapril, metoprolol) le tsona hangata li kenya letsoho ho ED.

TLHOKOMELISO TLALI

Ho bohlokoa ho theha moralo o felletseng oa kalafo bakeng sa ED, kaha ho ka etsahala hore o atlehe ho feta ho sebelisa moemeli a le mong ho sebetsana le matšoao feela.

TLHOKOMELLO SEPHEPHA

Phetisetso bakeng sa kalafo ea boits'oaro bo botle, taolo ea khatello ea maikutlo, kapa kalafo ea banyalani e ka ba e loketseng banna ba bang ba nang le ED. Kamano ea causal pakeng tsa khatello ea maikutlo le ED ha e hlake ebile e kanna ea qekotsa.61 Ebile, teko e le 'ngoe e laoloang e sa sebetseng (RCT) ea banna ba 152 ba nang le khatello ea maikutlo e bonolo le e fokolang ea maikutlo le ED e bontšitse maikutlo a ntlafalitsoeng ho banna ba fuoeng sildenafil ha ED ea bona e ntlafala.62 ED e bakiloeng ke matšoenyeho a ts'ebetso kapa khatello ea maikutlo e phekoloa hamolemo ka kalafo ea boits'oaro ea motho ka bo mong, tlhabollo ea likamano, kapa ho sebetsa le ngaka e netefalitsoeng ea thobalano. Ho boetse ho na le bopaki ba hore kalafo ea sehlopha e ka ntlafatsa ts'ebetso ea erectile. Tlhahlobo ea Cochrane ea liteko tse 11 tsa kliniki (tse robong tsa tsona li sa sebetsoa ka mokhoa o hlophisitsoeng), li fihlile qeto ea hore kalafo ea sehlopha sa thobalano e ne e sebetsa hantle ho feta ho se kalafo ea ED. Tlhahlobo ea meta-liteko ea ho bapisa kalafo ea sehlopha le sildenafil citrate khahlanong le sildenafil e le 'ngoe, e fumane hore banna ba fumaneng phekolo ea sehlopha le sildenafil ba bontšitse ntlafatso e kholo ea likamano tse atlehileng mme ba ne ba fokola ho feta ba amohelang sildenafil feela ho tlohela. Phekolo ea sehlopha le eona e ntlafalitse haholo ED ha e bapisoa le sildenafil citrate feela.63

HO FUMANA HO SEBELISOA HO BONAHALA PORNOGRAPHY

Ho feto-fetoha ha ED ho kopantsoeng le tšebeliso ea litšoantšo tsa bootsoa khafetsa ho hloka hore mokuli a felise litšoantšo tsohle tse litšila tse tsosang takatso ea ho sheba litšoantšo tse litšila tse tsosang takatso. Sena se lumella ho khutlisetsa bokhoni ba botona le botšehali bo kopaneng le bolekane ba 'nete. Leha nako ea ho "nchafatsa" kelello ka mokhoa oa ho qoba ho sheba litšoantšo tse litšila tse tsosang takatso ha e tsejoe, setsebi sa temallo ea litšoantšo tsa bootsoa Gary Wilson se fana ka maikutlo a bongaka le li-forum tsa marang-rang li bonts'a ho hlaphoheloa ha banna kapele ho feta lilemo tse 50, a fana ka maikutlo a hore likhoeli tse peli ke tse tloaelehileng.64 Bacha ba banyenyane ba ka hloka nako e eketsehileng, mohlomong ho isa ho likhoeli tse 5, ka khopolo eo tšebeliso ea bona ea litšoantšo tsa bootsoa inthaneteng e qalile ba le banyane. Ho tsosa takatso ea botona le botšehali ho na le maemo, haholo-holo nakong ea bongoana le lilemong tsa bocha, mme e ka ba matla ho banna ho feta ho basali.65-67

TLHOKOMELISO LITLHAKISO

Mesifa ea fatše ea pelvic e phethang karolo ea ho boloka li-erections li fokola ka lilemo. Phekolo ea 'mele ea ho matlafatsa bulbocavernosus le mesifa ea ischiocavernosus le tishu tse sebetsang li ka phekola ED ho bakuli ba bang. Phuputsong e le 'ngoe e sa laoloeng, e laoloang, banna ba 40 ba nang le ED ba ile ba rutoa ho khutlisetsa botoneng ka holimo le ho phahamisa mohala oa bona habeli letsatsi le letsatsi ha ba eme, ba lutse, ba robala,' me ba tiisa mesifa ea bona ea mokokotlo kamora ho ntša metsi. Liphetho li ne li makatsa - ka likhoeli tse 6, 40% ea bankakarolo ba fumane tšebetso e tloaelehileng ea erectile mme 35% e bonts'itse ntlafatso e itseng; 66% ea banna le eona e tlaleha ho fokotseha ha ho choachoasela ka mor'a ho ntša metsi. Mokhoa o bonolo e ka ba ho ruta bakuli ba banna Kegel ho ikoetlisa ka ho etsa hore ba emise ho hlatsoa moroto ho bona mesifa e tla hlokahala ho etsa boikoetliso. Mesifa ena e lokela ho kenngoa metsotsoana e 5, makhetlo a 10-20 ka tatellano, makhetlo a mararo ka letsatsi. Banna ba kanna ba hlohlelletsoa ho etsa koetliso ea ho matlafatsa tlase ho Kegel kapa pelvic ka lebaka la ntlafatso ea boleng ba orgasm, litla-morao tse tloaelehileng Arnold Kegel, MD o ngotse lilemo tse mashome tse fetileng ho basali ba neng ba etsa Kegels khafetsa.68

PUSELETSO EA VACUUM CONSTRICTION

Sesebelisoa sa vacuum constriction (VCD), seo ho thoeng se bitsoa "penis pump" se entsoe ke Geddings Osbon ka 1974.69 Osbon o ile a re ke "sesebelisoa se lekanang sa bocha" mme a re o se sebelisa ka lilemo tse 20 ntle le ho sitoa. Sesebelisoa sa pele sa vacuum constriction e ne e le FDA e lumelletsoeng bakeng sa ED ka 1982.

VCD e sebetsa ka ho eketsa phallo ea mali ho ea botoneng ka ho hlahisa khatello e mpe ea 110-225 mmHg (ka letsoho kapa ka pompo e sebelisoang ka betri) le ho thibela ho phatloha ha venous ka reng ea constriction. Boithuto bo bontša hore banna ba ka bang 55-70% ba ka fumana li-erections tse lekaneng le li-VCD.70, 71 Banna ba bang ba tlaleha hore moleko o fumanoeng ho VCD o batla o hlophisehile, o bata, kapa o le litšila, 'me litlamorao li kenyelletsa ho sithabela ha mohoma oa penile le ho ts'oaroa ha ejaculate nakong ea komiti ho tsoa sebakeng sa "constriction band". Molatsoana oa "constriction" ha oa lokela ho tloheloa sebakeng sa nako e fetang metsotso e 30 ka lebaka la kotsi ea ischemia.

DIET, TLHALOSO LE LITLHAKU TSE KHOLO

Patlo ea li-aphrodisiacs ho hlasimolla libido le ho ntlafatsa matsatsi a ts'ebetso ea thobalano ho tloha mehleng ea khale. Ha e le hantle, lentsoe aphrodisiac le tsoa ho molimotsana oa lerato oa Mogerike, Aphrodite, ea hlahileng leoatleng 'me a tlisoa lebokoseng la scallop kapa oyster. Le ha li-oyster li na le zinki tse ngata tse hlokahalang bakeng sa tlhahiso ea testosterone, ho li ja ha hoa bontšoa ho ntlafatsa bokhoni ba libido kapa erectile.

Lijo tse ling, leha ho le joalo, li ntlafatsa bophelo bo botle ba methapo, ka hona li ka ntlafatsa ts'ebetso ea erectile. Mohlala, lijo tse nang le nitrate tse ngata joalo ka li-beet le meroho e makhasi li phahamisa maemo a nitric oxide, li khothaletsa ts'ebetso e tloaelehileng ea endothelial le khatello e tlase ea mali.72-74 Peō ea kharenate le lero li boetse li ntlafatsa ts'ebetso ea endothelial le khatello e tlase ea mali ha li ntse li fokotseha le li-LDL tse halikiloeng, ka tsela eo li fokotsa sebopeho sa atherosselotic plaque le ho fokotsa botsitso ba lebota le thata.75-78 Li-syrup tsa poone tse phahameng le lino tse tahang li eketsa kotsi ea ho ba le lefu la metabolic, atherosulinosis, lefu la tsoekere le ED.79 Ntle le moo, lijo tse nang le lihlahisoa tse phahameng tsa glycation tsa ho qetela tse kang bacon, li-hamburger tsa lijo tse potlakileng, lintja tse chesang, chisi, pizza le lijo tse halikiloeng, li kenya letsoho mofuteng oa lefu la tsoekere, lefu la pelo le ED.80-82 Sebakeng sa ho shebana le ho qoba lijo tse khethehileng, ho ka ba molemo haholo ho bakuli ba ED ho amohela lijo tsa Mediterranean tse jang nama e ngata, litholoana, oli ea mohloaare e sa tsoakoang, lijo-thollo, linate le litlhapi le veine e itekanetseng. Bopaki bo tsoang litekong tse 'ne tsa tleleniki ea bongaka bo bontša hore lijo tsa Mediterranean le mokhoa oa bophelo o susumetsa tšebetso ea thobalano,83,84 hammoho le ho fokotsa ho ruruha le ho liehisa ho se sebetse hantle ho tsa thobalano ho banna ba lefu la tsoekere.

Ho na le ngangisano e nyane ea hore ho ikoetlisa ho ntlafatsa lintlha tse 'maloa tsa kotsi tse tlatsetsang ho ED ho kenyelletsa ho fokotsa ho ruruha, ho ntlafatsa ts'ebetso ea endothelial, ho khothaletsa kutloisiso ea insulin, ho ntlafatsa lipoprotein le ho matlafatsa tahlehelo ea mafura a visceral.85-89 Tlhahlobo ea morao-rao ea morao-rao le tlhahlobo ea meta li tiisa hore boikoetliso bo matla ho ea bo boholo bakeng sa libeke tse 8 bo ka ntlafatsa ED.90

Ka bobeli mafura a mangata a mmele le a sa lekanang a amahanngoa le ED. Mohlala, Hallym Aging Study e ile ea lekanya liperesente tsa mafura a mmele le kamano ea eona le ED ho banna ba Korea.91 Banna ba nang le mafura a tlase haholo le a phahameng ka ho fetisisa ba ne ba ka khona ho ba le ED. Ho nona haholo ho amana le 'mele oa metabolic, dysfunction le testosterone e tlase, tseo kaofela li kenyang kholisong ea ED.92,93 Lithane tsa mafura li boloka lihormone le li-cytokine tse fetang 35, hoo e ka bang kaofela ha tsona li khothalletsang ho ruruha, ho hanyetsa insulin, 'me qetellong, lefu la methapo.94,95 Ho ruruha ho bonahala e le sebapali sa bohlokoa sesosa sa ED. Banna ba nang le mafura a mangata ba nang le li-CD ba na le matšoao a ho fokola a tšoaetso (IL-6, IL-9, IL-18, le CRP) mme ts'ebetso ea endothelial e holofetseng ho feta banna ba batenya ntle le ED.96

Ho fokotsa boima ba 'mele ho ka ntlafatsa haholo ts'ebetso ea erectile. RCT e le 'ngoe, banna ba batenya haholo ba ileng ba lahleheloa ke boima ba liponto tse 33 ho feta lilemo tse peli ba ntlafalitse ts'ebetso ea thobalano.97 Ed e ntlafalitsoe ka karolo e fetang 30% ea sehlopha sa tahlehelo ea boima ha se bapisoa le 5% ea taolo. Sehlopha se kenelletseng se amohetse likeletso tsa phepo e nepahetseng, likeletso tsa ho eketsa boikoetliso ho isa ho lihora tse 3 ka beke, le likopano tsa khoeli le khoeli kapa tsa bimonthly. Ntle le tahlehelo ea boima ba 'mele ea 15%, banna ba sehlopha sa ho kenella ba boetse ba bonts'a phokotso ea matšoao a ts'oaetso IL-6 le hsCRP, ho ntlafatsa boemo ba bona ba kotsi ea pelo.

BOTANICALS LE AMINO ACIDS

Ts'ebeliso ea lisebelisoa tsa botaniki, limatlafatsi le litlhare tse ling tsa tlhaho ho matlafatsa ts'ebetso ea thobalano e eketsehile haholo ka lebaka la papatso ea inthanete. Ke mekhoa e seng mekae ea phekolo ea tlhaho e kileng ea lekoa ke batho ho ts'ehetsa ts'ireletso le katleho. Leha ho le joalo, li-botanicals le li-amino acid tse latelang li ka ba molemo ho phekoleng ED, haholo banna ba khethang ho se sebelise litlhare tsa PDE5i.

Pausinystalia yohimbe

Yohimbe ke letsoalloa le lulang le lula bohareng ba Afrika le nang le alkaloids tse tharo: rauwolscine, corynanthine le yohimbine. Sebaka se sebetsang sa yohimbe, yohimbine, ke setlama se nang le mochini o sebetsang o sebelisitsoeng e le mohanyetsi oa presynaptic α1 le α2-adrenergic le 5-HT (1B) li-receptors le agonist e sa lekanyetsoang ea li-receptors tsa 5-HT (1A).98 Meta-analysis e fana ka maikutlo a hore yohimbine e sebetsa ho ED99,100 Yohimbine e ka thusa ka ho lieha ho khona kapa ho se khone ho ntša.101 Tekanyetso ke 15-30 mg, ho fihla ho 100 mg ka letsatsi. Yohimbe e ka fanoa ka tlhoko ea hau ea pele ho tloha hobane e potlakile kapele, ka nako ea metsotso e 10-15, le bophelo ba metsotso e 35. Yohimbine e kenella ho tsamaiso ea methapo e bohareng ka litlamorao tse ka khonehang ho kenyeletsa tachycardia, khatello ea mali, ho teneha le ho tšoenyeha. Ho rohakana, ho nyekeloa, ho tsekela, ho opeloa ke hlooho le ho sesa ka letlalo le tsona ke lintho tse tloaelehileng. Joalo ka litlolo tsohle tsa lihlahisoa, litlatsetso tse ngata tsa tlatsetso li ka se ts'epahalle. Phuputso e le 'ngoe e lekang li-brand yohimbe tse 49 li fumane ho pharalla ho hongata ka palo ea yohimbine - 0 ho isa ho 12.1 mg - ka ho fana ka lihlahisoa tse 19 tse se nang rauwolscine le corynanthine, ho fana ka maikutlo a hore li tsoa semeleng se hlahisitsoeng hantle kapa sa maiketsetso.102

Tribulus terrestris

T. terrestris e hola Europe, Asia, Afrika le Middle East. Motso le litholoana li na le tšebeliso ea nako e telele ho meriana ea China le Ayurvedic. Litefiso li etsoa khafetsa hore Tribulus e ntlafatse tlhahiso ea testosterone; leha ho le joalo, liteko tsa tliliniki ha li tšehetse khopolo ena ntle le ts'ebeliso e kenelletseng ea lithutong tsa khale.103-106 Lithuto tsa liphoofolo li bontšitse hore Tribulus e ka ntlafatsa ts'ebetso ea erectile le tlhahiso ea NO.107,108 RCT e le 'ngoe ea banna ba 180 ba nang le bonolo-to-moderate ED ba sebelisang 500 mg ea maemo T. terrestris e nkuoe makhetlo a mararo letsatsi le leng le le leng e tlalehiloeng e ntlafalitsoeng ea libido, ED, khotsofalo ea likamano tsa botona le botšehali. Ha ho litlamorao tse tlalehiloeng.109

Eurycoma longifolia

Eurycoma longifolia, e tsejoang e le Malaysia ginseng kapa Tongkat Ali, ke semela se thunyang se tsoakiloeng Indonesia, Malaysia, Thailand, Vietnam, Laos le India. Tlhahlobo ea meta-RCTs e fana ka tlhahiso E. longifolia haholo ameliorates ED.110 Ntle le moo, tlhahlobo ea China ea lithuto tse hatisitsoeng e fana ka maikutlo E. longifolia e ntlafatsa boleng ba semen, libido, le testosterone.111 Semela se ka ba le bokhoni ba adaptogenic, mme se bontšitsoe ho fokotsa mokhathala, ho ntlafatsa bophelo bo botle, cortisol e tlase, le ho eketsa testosterone lithutong tse hatelletsoeng.112 Ho nkuoa e le motso oa metsi, Eurycoma e bonahala e sireletsehile ntle le litlamorao tse kholo. Motsoako o khothalelitsoeng ke 200-300 mg hang kapa habeli letsatsi le letsatsi, 'me o na le foromo e nang le tokelo ea matla ea 22% eurypeptides le 40% glycosaponins.

Epimedium spp.

Epimedium spp. hola Chaena le Korea, hape ke oa lelapa la Berberidaceae (le lona le nang le botanicals bo tsebahalang, Mahonia aquifolium, Hydrastis canadensis, 'me Berberis vulgaris). Bonyane ke mefuta e 50 e fumanoeng mme e tsejoa e le "mofoka oa poli ea horny". Motsoako o nahanang o sebelisoa, icariin, ke flavonoid e ntlafatsang ts'ebetso ea erectile lithutong tsa liphoofolo ka PDE5 inhibition le nitric oxide induction.113-115 - Liteko tsa tliliniki ea motho li Epimedium lia fokola; ka hona, likhothaletso tsa litekanyetso ha li fumanehe.

L-arginine

L-arginine ke amino acid, e bohlokoa maemong a nang le enzyme e eketsehileng ea arginase, e kang lefu la tsoekere le ho hloleha ha methapo.116,117 Arginine e sebelisoa ke enterocytes ea mala le hepatocytes mme e fetoloa L-citrulline kapa L-ornithine. Ho feto-fetoha ha monko oa molomo oa L-arginine hoa utloahala - litekanyetso tse 6 g li kenyelletsoa ka 68% ha litekanyetso li 10 g e le karolo ea 20% feela.118,119

Nitric oxide ke phetoho ea phetoho ea L-arginine ho citrulline. Ho feta moo, tlatsetso ea citrulline e eketsa plasma arginine. Arginine e ka ntlafatsa ED ho litekanyetso tse phahameng; mohlala, 5000 mg e ntlafatsa ED, haholo ha metabolite ea NO ea 'mele e le tlase.120 Ka theoretically, L-arginine e kanna ea sebetsa hantle ha maemo a ADMA a phahame. Kaha ADMA e thibela eNOS, enotme ea endothelial e hlokahalang bakeng sa tlhahiso ea NO, tlatsetso ea L-arginine e kanna ea theha tekanyo ea arginine-to-ADMA.121 Tlatsetso ea L-arginine e kanna ea sebetsa haholoanyane ho ED ha e kopantsoe le yohimbine kapa pycnogenol (bark ea phaene ea phaene Setho sa Pinus).122-124 Tlatsetso le L-arginine e ka etsa hore herpes e sebetse le ho eketsa ho phatloha. Ntle le moo, RCT e phatlalalitsoeng ka 2013 e tlaleha 3000 mg ea L-arginine e nkuoeng makhetlo a 3 ka letsatsi e eketsa kotsi ea lefu ho bakuli ba nang le MI ea morao-rao.125

LITLHAKISO TSA SEHLOOHO

Mekhoa e meholo ea pharmacological bakeng sa ED ke li-inhibitors tsa PDE5, apomorphine, le mekhoa ea kalafo ea ente ea entracavernosal.

PDE5 inhibitors

Phosphodiesterase mofuta oa 5 inhibitors (PDE5i) ke kalafo e atileng haholo ea lithethefatsi bakeng sa ED. Ts'ebetso ea bona ea ts'ebetso e tsejoa haholo, e thibela mofuta oa "phosphodiesterase" ea 5 e senyang cGMP, e lelefatsa mosebetsi oa NO ka methapo ea methapo ea methapo. Mekhoa ea litlhare ka sehlopheng sena e fapana maemong a bona a fapaneng a 11 a PDE isoenzymes. Ts'ebetso ena ea sefapano se nang le PDenz isoenzymes e fumaneha haholo mesifa, visceral le mesifa e boreleli ea pulmonary mme e kenya letsoho litlamorao.126 Mohlala, vardenafil le sildenafil li na le menyetla e meraro le e supileng ea ho hokahana le PDE6, enzyme ho retina e fetisetsang leseli ho lithahasello tsa methapo. Ho thibela enzyme ena ho baka pherekano ea pono ea mebala e tsejoang e le "chromatopsia."

Lithethefatsi tse 'ne tsa PDE5i li ngolisitsoe ke FDA - sildenafil ka 1998, vardenafil le tadalafil ka 2003, le avanafil ka 2012. Ha ho liteko tsa hlooho-ho-hlooho ho bapisa ts'ebetso har'a lithethefatsi tsena tse kileng tsa etsoa. Meriana ena e fapana ho qala, nako ea tšebetso le litla-morao.127 Ho qala ha sildenafil le vardenafil ke metsotso e 30-60 ka nako e telele ea lihora tse 10-12. Ho qala ha Tadalafil ke metsotso e 15-30 ho latela tekanyetso, nako e telele ka ho fetisisa ea lihora tse 36. Avanafil e na le nakoana e potlakileng ho feta, ka nako ea metsotso e 15, le bolelele ba lihora tse 6.

Ts'ebeliso ea PDE5i e ka fokotsa kotsi ea kankere ea senya ea senya, mohlomong hobane banna ba e sebelisang ba ka tsoa khafetsa khafetsa, e sirelletsang khahlanong le mofetše oa senya.128,129 Nako e telele sildenafil Ts'ebeliso ea citrate (Viagra) e amahanngoa le kotsi e eketsehang hanyane ka hanyane ea melanoma.130 Litlamorao tse atileng haholo tsa PDE5i li kenyelletsa hlooho ea banna ho isa ho 20% ea banna, ba fufuleloa ho fihla ho 15%, le dyspepsia le khatello ea methapo ho fihla ho 10%. Le ha e sa tloaeleha, ho tsekela le ho se tsepame ho ka hlaha. PDE5i kaofela li kopantsoe le banna ba nkang nitrate.

Apomorphine

Apomorphine e ntse e sebelisoa ho tloha ka 1869 bakeng sa lefu la Parkinson, 'me e ithutile ka phello ea eona mosebetsing oa erectile. Le hoja e tsoa morphine, apomorphine ha e na morphine kapa e tlama ho li-receptor tsa opioid. E na le tšebelisano e phahameng ea li-dopamine receptors le mokhoa oa ho ntlafatsa drive ea thobalano le li-erections ka mohlomong ka ho lumellana ho lekanang bakeng sa li-receptor tsa D2 tsamaisong ea hypothalamus le limbic.131 Boemong ba batho II le III liteko tsa tliliniki tse kenyelletsang banna ba 5000, 3 mg mg ea apomorphine e ikhethileng e hlahisitse li-erections tse lekaneng ho kenella kahare ho metsotso e 4-10, ka ntlafatso e ka bang 25-20% ho feta placebo.132,133 Apomynphine ea lithethefatsi feela e nang le tokelo ea molao e tsoang Amerika e ente ea Apokyn, FDA-e amohetsoeng ho nts'etsapele lefu la Parkinson; leha ho le joalo, apomorphine e ka eketsoa e le lozenge e ikhethileng mme e ka kopanngoa le PDE5i. Melemo ea 2-3 mg e ka sebetsa hantle joalo ka ea 4-6 mg ntle le litla-morao tse kang ho nyekeloa ke pelo, hlooho e opang kapa ho tsekela. Apomorphine ha ea lokela ho sebelisoa ka mokhoa o tšoanang le ondansetron hydrochloride, antiemetic e fanoeng khafetsa, ka lebaka la hypotension e ka khonehang.

Liente tsa intracavernosal

E hlahisitsoe ka 1983, liente tsa intracavernosal modate endothelial function mme li sebetsa hantle haholo ho banna ba nang le ED e matla; alprostadil e hlahisa li-erections ho banna ba ka bang 93%, ka katleho ea bi-, tri-, le quad -xube ea hofihlella ho fihla ho 97.6%.134-136 Alprostadil, 20 kapa 40 μg ea prostaglandin E1, ke eona feela ente ea tumellano ea tumello ea tumellano ea tumello ea FDA, athe meriana e meng e 'meli, phentolamine le papaverine e ka eketsoa ka PGE1 ka foromo e kopantsoeng. Litlamorao tse atileng haholo tsa PGE1 feela ke bohloko ho 48.5% ea banna. Ho kopanya ka Bi-bi, eo hangata e nang le 0.5-3.0 mg ea phentolamine le 30 mg papaverine, ha e utloise bohloko empa e kanna ea se sebetse. Ho kopanya ka makhetlo a mararo, hangata ho nang le 5-10 μg (le ho fihla ho 40 μg) ea PGE1, 0.5-1.0 mg phentolamine, le 15-30 mg papaverine, ho fokotsa monyetla oa ho utloahala ho 2.9%. Ho kenyelletsoa ha 0.15 mg ea atropine ho quad -xube, e bolokiloeng ho banna bao ho kopanya motsoako ho sa sebetseng, ho ammeng bohloko bo boholo. Lenane la PGE1, bi-, tri-, kapa quad -xube le hlokahalang le fapana ho tloha ho 0.1 ho isa ho 0.3 mL. Empiric (e sebelisa PGE1 feela ho sa tsotelehe etiology ea ED kapa ho teba ha eona, ka litekanyetso kapa liphetoho tsa formula tse entsoeng ho latela sephetho sa bakuli) le tse bakang likotsi (sebelisa motsoako oa bi-Remix, tri-mix, kapa high-dose-motsamaisi o thehiloeng ho algorithm factoring ED etiology le palo ea lintlha tsa likotsi tsa ED) litsela tse sebelisoang ho dosing li shebahala li ts'oana mabapi le litekanyetso tsa katleho le mathata le khotsofalo.137 Litla-morao li kenyelletsa bohloko sebakeng sa ente ea ente, priapism, le nts'etsopele ea lisele tsa letlalo kapa lefu la Peyronie. Bakeng sa sengoloa se hlahlobang ho sebetsa hantle, litekanyetso le litlamorao tsa ente ea intracavern, akaretsa kakaretso ea Medscape "Intracavernosal Injection Algorithm" ea Jeffrey Albaugh.138

BONT .A KOTSI-LITLHAKISO TSA BOPHELO

Low intensity extracorporeal shockwave (LI-ESW) e simolohile ka bo 1990 ha ho ne ho bontšoa hore ultrasound e kenya angiogeneis ka maqeba a rat.139 LI-ESW e sebelisa maqhubu a tšosang, mofuta oa maqhubu a moea o nang le matla le a etsang hore lintho li fetohe ha li sebelisoa ho lisele tsa 'mele.140 Ts'ebetso e fapana ho latela matla a feberu ea flux, khafetsa (palo ea methapo ka motsotsoana ho Hz), le palo eohle ea liphallelo tse tlisoang. Mochine oa ts'ebetso bakeng sa ntlafatso ea ED o bonahala e le nchafatso ea methapo ea methapo ea methapo ea methapo ea methapo (nNOS) e ntle, tokollo e ntlafalitsoeng ea nitric oxide, le endothelial le vascular smooth misuli cell cell ka ho hira lisele tsa mesenchymal stem.141 Phekolo e kanna ea tsosa lisele tsa lehae tsa "penile progenitor".142 Hajoale, LI-ESW ha e amoheloe FDA bakeng sa ED; leha ho le joalo, liteko tse ngata tsa kliniki li entsoe ka profil e ntle ea polokeho le katleho e fapaneng.

Boithuto ba pele ba ED bo phatlalalitsoeng ka 2010 bo sebelisitse likarolo tse tšeletseng tsa LI-ESW ho banna ba 20 bao e neng e se likarabo ho PDE5 inhibitors (PDE5i). Liphetho li bonts'itse ts'ebetso e ntlafalitsoeng ea erectile, nako ea li-erections le ho thatafala ha penile ka khoeli e le 'ngoe. Lintlafatso li tlalehiloe hoo e ka bang likhoeli tse 1 tsa ho latela.143 Li-RCT tse 'maloa li tlalehile liphetho tse ntle li sebelisa LI-ESW. Tekong e le 'ngoe e kenyelletsang banna ba 67 ba nang le ED ba arabileng ho PDE5i, letsoho la kalafo le amohetse likarolo tse 12 tse nang le tšebetso e ntlafalitsoeng ea erectile le penile hemodynamics e bonoang ho banna ba ka bang 50% ntle le ts'ebeliso ea PDE5i.144 Ka RCT e ts'oanang ho India ho kenyelletsa ba arabelang ka PDE135i ba 5 ba ileng ba tšoaroa ka linako tse 12, 78% ea banna ba tšoaroang ba ile ba khona ho fihlela li-erections tse lekaneng bakeng sa ho kenella ntle le moriana ka khoeli ea 1.145 Le ha liphetho tsena li ile tsa ntlafatsoa kamora ho latela selemo sa 1, ho ne ho na le sekhahla se phahameng haholo sa ho theoha ho kenyelletsa 58% ea sham le 42% ea matsoho a kalafo.

Banna ba sa arabeng PDE5i e kanna ea ba karabo kamora kalafo ea LI-ESW. Moqoqong o bulehileng, phuputso e le 'ngoe e lebelletsoeng ea banna ba 29 ba sa arabeng PDE5i, kalafo tse 12 li felletse ka hore 72% ea banna ba atlehe ho fihlella li-erections tse ts'oanelehang ho kenella kahare ho PDE5i.146 RCT ea morao-rao e kenyelletsa batho ba sa arabeng ba PDE58i ba 5, 54% e arabetse PDE5i kamora khoeli e le 'ngoe ea kalafo ea LI-ESW ha e bapisoa le 1% sehlopheng sa sham.147

Ntlafatso e tsitsitseng e bonoang lithutong tse latelang tsa tlhahlobo e bontša hore kamora kalafo, banna ba bang ba ka khutlisetsa ts'ebetso ea mantlha e bakang ED ea bona kapa hore LI-ESW e ka fana ka ntlafatso ea penile. RCT e le 'ngoe e ileng ea latela banna ba 6 ea ho latela banna ba 112, bao kaofela ba fumaneng lingaka tse hlano tsa kalafo ho tloha ha letsoho la placebo le amohetse kalafo e sebetsang libekeng tse 10, ka likhoeli tse 6, hoo e batlang e le 20% ea letsoho la kalafo la kalafo le 23% ea pele e phekotsoeng sehlopha sa placebo se ne se ntse se khona ho etsa thobalano ntle le meriana.148 Tlhahlobo e 'ngoe ea banna ba baholo ba 1 (lilemo tse pakeng tsa lilemo tse 50) tse nang le mabaka a kotsi ea vascular ho kenyeletsa lefu la tsoekere, khatello ea maikutlo, dyslipidemia, le lefu la methapo ea methapo ea methapo e fumane ntlafatso e tsitsitseng ea boleng ba ED le boleng ba ho its'oara bo tlalehileng.149

Palo ea kalafo ea LI-ESW bakeng sa sephetho se nepahetseng le hore na kalafo e lula e sebetsa halelele ha e tsejoe. RCT ea morao-rao e etsahetse ho banna ba 126 sepetleleng sa Danish ha ba bapisa banna ba fumaneng likopano tse hlano le tse leshome ho likhoeli tse 6 le tse 12; kalafo e ne e batla e le 38% e sebetsang lihlopheng ka bobeli, ho fana ka maikutlo a hore linako tse ling li ka 'na tsa se ke tsa ntlafatsa sephetho.150,151 Thutong e latelang ea lilemo tse 2 ea teko ea mabitso e bulehileng ea banna ba 156, 63% e ntlafalitsoe ka libeke tse 4 le ts'ebeliso e ntle ea 53% lilemong tse peli.152 Ha ho makatse hore banna ba nang le ED e matla ba ile ba hloleha pejana. Bakuli bohle ba nang le lefu la tsoekere le ED e matla ba lahlehetsoe ke ts'ebetso, athe banna ba etsang liphesente tse 76 ba nang le lefu le fokolang la lefu la tsoekere ba ne ba sa sebetse hantle.

Palo ea lithuto tse sebelisang LI-ESWT bakeng sa ED e eketsehile haholo lilemong tsa morao tjena. Tlhahlobo e phetoang ea lingoliloeng tse phatlalalitsoeng tse entsoeng ka 2013 e tlaleha hore 60-75% ea babuelli ba PDE5i ba ka fihlella li-erections tse lekaneng bakeng sa ho kenella ntle le meriana mme 72% ea batho ba sa arabeng ba PDE5i e ile ea fetoha babuelli.153 Boithuto ba morao-rao ba boithuto ba ho hlahloba lithuto tse 14 ho kenyelletsa le li-RCTs tse 7 li fumane hore kalafo ea LI-ESW e bolokehile ebile e sebetsa, 'me ho na le liphetho tse nkang bonyane likhoeli tse 3.154 Banna ba nang le ED e bonolo kapa e leka-lekaneng ba bonahala ba e-na le karabelo e ntle ho feta banna ba nang le ED e matla, le matla a flux flux, palo ea maqhubu a tšohanyetso a tlisoang, le nako ea kalafo e tsamaisanang hantle le sephetho.

PRP LE STEM CELL INJECTION

Ho kenngoa ha lisele tse nang le methapo ea methapo ea methapo kapa mesenchymal stem ka har'a cous cavernosum ho tšepisa ho ntlafatsa ED le ho khutlisa ts'ebetso ea methapo ea methapo le methapo. Ho lokisa PRP, liplatelete tse tsoang maling a khahlantsoeng a felisoa ka centrifuge 'me li kenelle. PRP e na le liprotheine tse fetang 300 tsa bioactive, lintlha tsa kholo, le limolek'hule tsa khokahano tse ka ntlafatsang ho phekola lisele le ho khothaletsa ts'oarelo ea methapo le methapo.155-157 Kaha penile vasculature ke sebaka se ruileng ka ho fetesisa sa 'mele oa motho le phallo ea mali kahara botoneng bo futsanehileng butle ha e bapisoa le ho potoloha ha kemiso (ho lumella ho bolokoa hamolemo), ka thero, PRP e ka fana ka melemo lithaneng tsa penile tse ts'oanang le ntlafatso e bonoang ke likotsi tsa masapo a methapo. .

Ke lithuto tse fokolang tsa polokeho le monyetla oa ho sebelisa PRP bakeng sa ED tse phatlalalitsoeng. Teko e le 'ngoe ea motho e entsoeng Italy e ile ea hlahloba banna ba 9 ba nang le ED ba fumaneng PRP ho tlatselletsa kalafo ea vacuum. Ho ntlafala ha bonolo ho ile ha bonoa ke phello e nyane e bohloko ea bohloko bo bobe le ho longoa sebakeng sa ente.158

Tekanyetso e fokotsang ea lisele tse potolohileng tsa prootitor (EPCs), e leng mofuta oa sele e hlokahalang ho nchafatsa lesapo la methapo ea methapo, ke boemo bo ikemetseng ba kotsi ho ED.159 Li-EPC li fokotsehile ka ts'oaetso e sa foleng e bonoang ho lefu la tsoekere, hypercholesterolemia, botenya, lefu la pelo le ho tsuba koae.160 Lithuto tsa liphoofolo li bolela hore testosterone e matlafatsa khothalletso ea EPC ho tloha moko oa masapo le ho ntlafatsa angiogeneis.161,162 Tlhahlobo e 'meli ea lithuto tsa liphoofolo tse phatlalalitsoeng tse kentsoeng ente ea intracavernosal ea lisele tsa masapo tse tsoang mokokotlong oa masapo, mesifa ea adipose le mesifa ea marapo e tlalehiloe ka litholoana tse ntle mabapi le endothelial, mesifa e boreleli le ts'ebetso ea methapo liseleng tsa penile.163,164

PRP le kalafo ea lisele tsa bakoang li ka thusa banna ba nang le likotsi tsa methapo le methapo ea methapo ho tsoa ho lefu la tsoekere kapa prostatectomy e matla. Boithuto bo fokolang ba batho ba lifofane bo bontša hore mokhoa ona o ka ba o sireletsehileng hape o sebetsa. Phuputso e 'ngoe e ne e ama banna ba 11 ba neng ba e-na le radatectomy e matla ka lebaka la mofetše oa lefu la senya,' me sena se ile sa etsa hore ED e se ke ea arabela PDE5i.165 Lisele tsa mofuta oa "stemous" tsa "adipose" tse tsoang ho corpus cavernosum li ile tsa fumana tšebetso ea erectile ho banna ba robeli ho ba leshome le motso o mong ntle le mathata. Phuputsong e 'ngoe ea sefofane e sebelisang lisele tsa stem ea motho ea sa ikatiseng, banna ba baholo ba tšeletseng ho ba supileng ba nang le lefu la tsoekere le ED ba sa arabeleng PDE5i, ba ile ba boela ba e-ba teng hoseng ka khoeli ea boraro,' me ba babeli ho ba supileng ba ne ba ntse ba khona ho fihlela mohopolo le PDE5i kamora likhoeli tse 6. Ho khahlisang, tsoekere ea mali e fokotsehile libeke tse peli kamora ho entoa, ka maemo a hemoglobin A2C a ntlafalitsoe ho isa ho likhoeli tse 1, mme ha ho litlamorao tse mpe tse ileng tsa bonoa. Liphetho tse ntle li ile tsa boela tsa bonoa thutong ea sefofane sa motho e kenyelletsang banna ba 4 ba nang le bothata bo matla ba post-radical prostatectomy ED ba sa arabeleng ho alprostadil, PDE12i, kapa sesebelisoa sa vacuum.166 Mohato ona oa pele ke ile ka sebelisa litekanyetso tse ntseng li eketseha tsa lisele tse bakoang ke masapo tse tsoang ka mokokotlong. Methapo e phahameng e ne e sebetsa haholoanyane le banna ba robong ho ba leshome le metso e 'meli ba neng ba khona ho fihlela li-erections li tiile bakeng sa ho kenella ka PDE5i; melemo e ne e tšehelitsoe ka selemo se le seng ntle le litlamorao tse mpe.

Ha liente tsa PRP le tsa stem li nkuoa e le liteko mme li sa fumane tumello ea FDA le inshorense, banna ba ka batla lingaka tse etsang tšebetso ena. Litlamorao tse ka ba teng tse kenyelletsang tšoaetso le nts'etsopele ea lisele tsa letlalo kapa lefu la Peyronie. Ka thelori, lisele tsa stem li kanna tsa eketsa le tumorigene, leha ho le joalo, hore na kotsi ena ha e tsejoe e kae.167

QETELLO

Ho hloka taolo ea Erectile ke bothata bo tloaelehileng ba bongaka bo nang le lintho tse 'maloa tse ka khonehang, hangata bo baka lintho tse tlatsetsang le lisosa. Ho nka histori ka hloko le ka botlalo, tšebeliso ea lipotso tse netefalitsoeng, tlhahlobo ea 'mele, le ho ikoetlisa li hlokahala ho hlahisa moralo oa ho khahlisa matšoao ha o ntse o sebetsana le lisosa tsa sesosa. Likhetho tsa kalafo li kenyelletsa liphetoho tsa mokhoa oa ho ja le mokhoa oa bophelo, boikoetliso ba 'mele, tšebeliso ea lisebelisoa tsa phepo, botanical and amino acid supplements, meriana, kalafo e matla ea extracorporeal shockwave,' me mohlomong le liente tsa plasma kapa stem cell intracavernosal.

LITLHAKISO TSA TLHALOSO EA CLINICAL
  • Etsa nalane e phethahetseng, litokomane tsa lipotso, tlhahlobo, mosebetsi o nepahetseng oa lab
  • Buisana le lisosa / tlatsetso:
    • Psychogenic
    • Neurological
    • Tšebeliso e mpe ea litšoantšo tsa bootsoa
    • Endocrine
    • Litla-morao tsa meriana
    • Liphetoho tsa vascular
  • Lekola likhetho tse loketseng tsa kalafo:
    • Tlhabollo ea kelello
    • Boitšoaro ba bootsoa
    • Phekolo ea 'mele (Kegel's) kapa ts'ebeliso ea sesebelisoa sa vacuum constriction
    • Liphetoho tsa lijo
    • Ho khothaletsa boikoetliso
    • Likhetho tsa ho fokotsa boima ba 'mele
    • Litlhare tsa litlama le li-amino acid
    • Meriana:
      • PDE5i: linako tse fapaneng, nako ea ketso, le litla-morao
        • Mohlomong kapa ha e koaetsoe ke inshorense, e ka ba theko e boima
        • Apomorphine, eseng FDA-e lumelletsoeng bakeng sa ED, e tlameha ho eketsoa
    • Sekhahla se matla sa extracorporeal shockwave
    • Ha e amoheloe ke FDA bakeng sa ED le ho haella ha inshorense
    • Lintlha tsa polokeho li ntle ka lithuto tse ngata tse bonts'a liphetho tse ntle
    • E ka hloka kalafo e phetoang
  • PRP le ente ea sele ea stem
    • Ha e khothalletsoe ka lebaka la khaello ea liteko tse sa reroang le ho ameha ka polokeho
HO ETSA LINTHO TSE KHOLO

Sengoli se phatlalatsa hore ha a na thahasello ea tlholisano.

LITLHAKISO TSA KHOTSO LE CHELETE

Ha ho thuso ea lichelete ea ho hlophisa sengoloa sena.

LITLHAHISO
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DOI: https://doi.org/10.14200/jrm.2019.0104

Hlokomela: Seteishene sa data se ipapisitseng le nomoro ea 6 ke https://bedbible.com/sex-frequency-statistics/.