Isikolo seYunivesithi yaseBoston
Ukungasebenzi kwe-Erectile yinkinga ebalulekileyo yonyango. Ucwaningo lwangoku nje lwezifo lubonisa ukuba malunga ne-10% yamadoda aneminyaka eyi-40-70 ine-drective function epheleleyo okanye epheleleyo, echazwe njengento engenakho ukufikelela okanye ukugcina izilungiso ezaneleyo zokusebenza ngokwesondo. I-25% eyongezelelweyo yamadoda kule nqanaba yobudala inobunzima bokulinganisela okanye obuphakathi. Ingxaki ixhomekeke kakhulu kwixesha elide, njengoko ukuxhomekeka kokudibeneyo kokugqitywa kokugqitywa kwe-erectile ukungasebenzi kuyaphuma malunga ne-22% kwi-40 yobudala kwi-49% nge-70 yobudala. Nangona ingaqhelekanga kumadoda amancinci, ukungasebenzi kwe-erectile kusasaza i-5% -10% yamadoda engaphantsi kwe-40. Iziphumo ezivela kule zifundo zibonisa ukuba ukungasebenzi kwamandla erectile kunempembelelo enkulu kwiimeko zesimo sengqondo, ukusebenza komsebenzi kunye nomgangatho wobomi bonke.
I-Erectile i-dysfunction ihambelana ngokubanzi kwimpilo yomzimba kunye nengqondo. Phakathi kwezinto ezinobungozi eziphezulu zesifo sikashukela, isifo senhliziyo, isifo sengqondo segazi kunye nokuncipha kwamazinga e-HDL. Amachiza wesifo sikashukela, umfutho wexinzelelo, isifo sengqondo kunye nokudakumba kunokubangela ubunzima be-erectile. Ukongezelela, kukho ukuxhaphaka kwe-erectile phakathi kwabantu abaye bafumana umbane okanye utyando lwe-prostate yomhlaza, okanye ngubani onobungozi obuncinane bomnxeba okanye ezinye izifo ze-neurological (isifo se-Parkinson, multiple sclerosis). Izinto zokuphila zesitayela, kuquka ukutshaya, ukusetyenziswa kotywala kunye nokuziphatha kokuhlala kwimeko yongcinelelo. I-correlates yengqondo ye-erectile i-dysfunction iquka ukuxhalaba, ukudandatheka kunye nomsindo. Nangona ukwanda kwawo kwindoda phakathi kwamadoda amadala, ukungasebenzi kwe-erectile akubheki njengento eqhelekileyo okanye engenakukuphepha yokuguga. Akunqabile (kwii-5% zamatyala angaphantsi kwe-XNUMX) ngenxa ye-hypogonadism enxulumene nokuguga, nangona ubudlelwane phakathi kokungasebenzi kwe-erectile kunye nokunciphisa i-androgen enxulumene neminyaka kusekho mpikiswano.
Ukukhubazeka kwe-Erectile yimeko kunye nemiphumo enengqondo yengqondo kwaye inokuphazamisa ukuhlala kakuhle kwabantu, ukuzithemba kunye nobudlelwano bobuhlobo. Uqikelelo olusisigxina lwezenzo zalo lwenziwa phakathi kwe-10-20 yezigidi zabantu. Ukongezelela koko, kuboniswe ukuba iingxaki ze-erectile zihambela i-400,000 ukuvakatyela ugqirha wegulane, ukuhanjelwa kwezibhedlele ze-30,000 kunye nokukhutshwa kwemali yonyaka ngemveliso yethu yezempilo ye-146 yezigidi zeedola.
Ingxelo kaKinsey kwi-1948 yayisisifundo sokuqala ukujongana nokungasebenzi kwezesondo ngokobonke abantu. Iziphumo ezivela kulo mbuzo, ngokusekelwe kwingxowa-ndlebe exacileyo ye-12,000 yamadoda, echanekileyo kwiminyaka yobudala, imfundo kunye nomsebenzi, ibonise izinga elikhulayo lokungenamsebenzi kunye nobudala. Ukuxhaphaka kwayo kwakukhankanywe ngaphantsi kwe-1% kumadoda phantsi kweminyaka eyi-19 ubudala, i-3% yamadoda phantsi kwe-45 iminyaka, i-7% ngaphantsi kwe-55 iminyaka kunye ne-25% ngeminyaka eyi-75. Ku-1979, uGebhard uphinde wachaza idatha yaseKinsey kunye ne-chort yabantu abangaphezu kwamawaka amahlanu, i-42% yavuma kwiingxaki ze-erectile.
Olunye uphando olwenziwe kwizifundo ezivela kwiindawo eziqhelekileyo zineengxaki ezibini, ukusetyenziswa kweesampuli ezingabonakali ngenxa yendlela yokwenza isampula kunye nexabiso elingenakuthathwa kwesixhobo esisetyenziswe kwisifundo. I-Ard, kwi-1977, ibike malunga nokuziphatha ngokwesondo kwezibini ze-161 ezitshatileyo kuneminyaka engama-20 kwaye zaphawula iziganeko ze-3% zeengxaki ze-erectile. Kwi-1978, uFrank wafunda i-100 imibhangqwana yokuzithandela, kuthiwa yinto evamile, eyatshatileyo kwaye ixhatshazwa ngokwesondo, ineminyaka engama-18 ubudala. Amaphesenti angama-40 kwindoda abika ubunzima kunye nokuphakanyiswa kwe-ejaculation. Ngomnyaka kamva, iNettelbladt ifumene ukuba i-37% yekhethi ekhethiweyo, abesilisa abathandana ngokwesini (iminyaka engama-80 ye-40) baqaphela ubuncinane beengxaki ze-erectile. Olunye uphando luchaze iziganeko eziguquguqukayo zokukhubazeka kwe-erectile, ukusuka kwi-31-3%. I-Baltimore Longitudinal Study of Aging ephawulwe ngokukhubazeka kwe-erectile njengokuba ikhona kwi-40% yamadoda eyi-8 iminyaka okanye ngaphantsi, i-55% ye-25 ubudala, i-65% ye-55 ubudala kunye ne-75% ye-75 ubudala. I-Charleston Heart Study Cohort ibike malunga nomsebenzi wesondo kunokuba i-erectile dyfunction. Ingxelo yecandelo le-80% lokungasebenzi phakathi kweminyaka eyi-30-66. Kwizifundo ezingaphezu kweminyaka eyi-69 eli nani liphakama kwi-80%.
Izifundo ezifunyenweyo kwiinkcukacha zempilo yezokwelapha ziye zahlaziywa ngenxa yenkinga ye-erectile. Kuhlalutyo lweentsapho ezigulisa izigulane, u-Schein waphawula ukubandezeleka kobunzima be-erectile ye-27% kwizigulane ze-212 ezineminyaka engama-18 ubudala. U-Mulligan ucacise ukwanda kwe-35 kwindleko ze-erectile kumadoda angama-middle-middle age eneempilweni ezibizileyo, kunye nokunyuka kwe-6 kwizigulane ezifanayo kwiminyaka eyi-40 ubudala. Kwinqanaba labantu abadala be-70 abanesidlo kunye nokuhlolwa komnxeba jikelele, uMorley wathola isigxina se-50% sokungabi namandla. Oku kufunyaniswa kukuhambisana nezinye iinkcukacha ezivela kwi-Masters kunye no-Johns kunye neSlag, ebonisa ukuba amadoda anezifo zonyango anesiganeko esiphezulu sokungasebenzi kwe-erectile.
Isifundo saseMassachusetts Male Aging Study (MMAS) sasiyinxalenye esinqamlekileyo, esekelwe kuluntu, isampula-sampulu, uphando oluneengxaki ezininzi ze-epidemiologic yokuguga kunye nempilo kumadoda aneminyaka eyi-40-70 iminyaka. Uhlolisiso lwenziwe phakathi kwe1987-1989, naseBoston. Izimpendulo zezifundo ze-1290 zavandlakanywa emva kokulawulwa kweso sixhobo esiphezulu se-questionnaire. Lo msebenzi umelela umsebenzi omkhulu kunako kwiNgxelo yeKinsey kwi-1948. Ucwaningo lwe-MMAS lwaluhluke kwiingcali zangaphambili kwizikhulu zombini kunye nomxholo. Kwakuquka iindidi ezine zokungenelela ezithintekayo (ukudibanisa) ezinokudityaniswa nomsebenzi wesondo: isimo sezempilo kunye nokusetyenziswa kweenkonzo zonyango, i-data yoluntu, impawu zengqondo kunye neendlela zokuphila.
Yonke idatha yaqokelelwa kwikhaya leengxoxo ngabagadi-ndlebe abaqeqeshiwe. Iindlela ezahlukeneyo zabafundi zazibandakanya i-gerontologists, izazinzulu zendlela yokuziphatha, i-endocrinologists kunye neekliniki zokungasebenzi kwezesondo. Uyilo loyilo luye lwavumela ukuqikelelwa ngokuchanekileyo kweeramitha eziphambili ngelixa kulawulwa ngabadibanisi abangabalulekanga kunye nokuchongwa okuvumelekileyo kwimiba engozi yobungozi. Iqela lesampulu lalingasondelene noluntu jikelele njengoko lunokufezekiswa. Inani labantu ababefundiswanga liqela lokuzikhethela, elingekho liziko, kuphela iqhekeza eligula kwaye lidibene nenkqubo yezempilo.
Insimbi ye-MMAS equze imibuzo ye-23, i-9 yayo enxulumene nokukwazi u-erectile. Ukuhlola okuzithobayo kwe-erectile potency yenziwe ngokuchasene ne-erectile ye-dysfunction state. Uphononongo olwenziwe ngokulandelelana lwaluqhutyelwa ukucwasisa iinkcukacha ezahlukeneyo zobungakanani. Ubungakanani behlukaniswe ngamabakala e-4: ayinamandla, ayinamandla okuncinci, angenamandla kwaye akanamandla ngokupheleleyo.
Ireyithi epheleleyo yantoni na yokungakhathali i-MMAS yayingu-52%, kubandakanywa i-17% encinci, i-25% engenamandla kwaye i-10% ayinamandla ngokupheleleyo.Ukunokwenzeka ukungabikho kwamandla, nakweyiphi na iqondo, kwi-40 iminyaka yayingu 39% nakwi-70 iminyaka 67%. Ukuqulunqa le nkcukacha, kuya kuba ne-30 amadoda angamawaka e-United States ngeendlela ezithile zokukhubazeka kwe-erectile. Iimeko ezinxulumene nokungabi namandla kule sifundo zibandakanya, isifo sikashukela, isifo segazi, isifo senhliziyo, isifo sesilonda esingapheliyo, isifo se-arthritis, imithi ye-cardiac (kuquka i-vasodilators kunye nama-anthypertensive agent) kwi-smoking cigarette, i-agent-aglycemic agents and depression.
Umbutho phakathi kwesifo se-vascular kunye ne-erectile dysfuncion iye yaqatshelwa kwaye ichaneke kakuhle. Enyanisweni, utshintsho kwi-hemodynamics ye-vascular (kungakhathaliseki, ukungafihli komzimba okanye ukungasebenzi komzimba) kukholelwa ukuba yinto ebangelwa yinto engavumelekanga ye-erectile. Isifo esinjalo se-vascular njenge-infyoction ye-myocardial, i-coronary artery optic operation, izingozi ze-cerebral vascular, izifo zesifo se-vascular and hypertension zonke ziboniswe ukuba zineziganeko eziphezulu zokungafananga nokuthelekiswa kwabantu abemi ngaphandle kwe-vasculopathies. I-infyoction ye-Myocardial (MI) kunye ne-corornary artery optic operation idibene neengxaki ze-erectile kwi-64% kunye ne-57% ngokulandelanayo. Ngaphezu koko, kwiqela lama130 angenamandla, iziganeko ze-MI zaziyi-8 amaxesha aphakamileyo kumadoda anee-indices ze-penile-brachial (PBI) ezingaqhelekanga kunezo eziqhelekileyo ze-PBI (12% vs 1.5%). Kwindoda enezifo zesifo se-vascular (PVD), iziganeko ze-erectile dysfunction ziqikelelwe kwi-80%. Eli nani li-10% kwindoda enesifo esiphezulu.
Isifo sikashukela kunye ne-vasculopathy yayo edibeneyo sinxulumene nesiganeko esiphezulu sokungabi namandla kwiminyaka yonke xa kuthelekiswa noluntu jikelele. Ubuninzi bobuthathaka kwi-all-comer diabetics buyekelelwe ngokuthelekiswa phakathi kwe-35 kunye ne-75%. Ingxaki ye-Erectile ingaba yi-harbinger yesifo sikashukela, le nto ibonakalayo kwi-12% yabasifo be-diabetics abasanda kufumana. Isiganeko sokungabi namandla kubantu abanesifo sikasifo sikashukela sinokuxhomekeka kwiminyaka kwaye siphezulu kwindoda enesifo sikashukela esifana nesantwaba-ntlupheko. Kulabo bantu besifo sikashukela abaya kuhlakulela ukungabikho amandla i-505 baya kwenza njalo ngaphakathi kwe-5-10 iminyaka yokuxilongwa kwesifo sikashukela. Xa zidibaniswe nezifo ezingasondelanga kwi-diabetics zixhaphake ngakumbi.
Njengoko inani lezinto ezinobungozi be-vascular (ezifana nokubhema ugwayi, ukutshatyalaliswa kwegazi, isifo senhliziyo, i-hyperlipidemia, nesifo sikashukela) kwanda ngokunjalo kwaye kunokwenzeka ukuba kubekho ukungasebenzi kwe-erectile. Oku kufumanisiweyo kwaqinisekiswa kwindlela yokuhlalutya kwe-Virag yama-400 amadoda angenamandla, ebonisa ukuba i-80% yala madoda ayenempilo engafanelekiyo kwaye izinto ezinobungozi beengcambu zaziqhelekileyo kweli qela xa kuthelekiswa noluntu jikelele.
Nangona i-androgens ibalulekile ekukhuleni nasekuhlukisweni kwendlela yomzimba wesini, ukuphuhliswa kweempawu zesondo zesibini kunye nokuba khona kwe-libido indima yabo kwinkqubo ye-erectile ihlale ingacacile. Kulo xesha, uhlobo lophando olufanelekileyo lwe-hormone, nokuba ngaba iipaneli ezipheleleyo ze-hormone iyadingeka kuyo yonke isigulane okanye ukuba isisombululo esisodwa se-testosterone senza uvavanyo lokusebenza ngokuqhubekayo siyaqhubeka. Enyanisweni, akukho nto ingavumelaniyo nokuba ingaba amahhala okanye amanqanaba e-testosterone ayabaluleke kakhulu ekuhloleni kwakhe indoda engenamandla. Nangona kunjalo, i-endocrinopathies i-akhawunti ye-3-6% ye-erectile i-dysfunction kunye nezo-endocrinopathies ezikhokelela ekungabikho amandla ziquka u-hypogonadism, i-hypothyroidism, i-hyperthyroidism, i-hyperprolactinemia, isifo sikashukela, isifo se-adrenal, isifo esingapheliyo sesibindi, ukungaphumeleli kwintsholongwane kunye ne-AIDS.
Ukusetyenziswa kakubi kwezidakamizwa erectile kuyinto eqhelekileyo kwaye uluhlu lwamachiza anokunyusa usebenzo lwe-erectile lubalulekile. Ukulinganiswa kwamandla okuxhatshazwa ngamachiza kuye kwacatshangelwa kufike kwi-25% yezigulane kwikliniki yokugula. Ama-anthypertensive agents adibene ne-erectile disifulties, kuxhomekeke kwii-agents ezithile kwi-4-40% yezigulane. Benza ukuba abangenamandla bangabikho ngamanyathelo kwizinga eliphambili (clonidine), ngezenzo ezithe ngqo kwizinga lombutho (i-calcium channel blockers) okanye ngokuyeka ukutshintsha kwangaphambili kwegazi apho isigulane sithembele kwi-mainatin ingcinezelo ye-intracorporal eyaneleyo ekuphuhliseni ipenile ngqongqo.
Amachiza amaninzi abangela ukungabikho kwemisebenzi esekelwe kwizenzo zabo zokulwa ne-androgen, umzekelo i-estrogens, i-LHRH, i-HHNUMX, kunye ne-spironolactone. I-Digoxin inciphisa ubunzima be-erectile ngokukhutshwa kwipompo ye-NA-K-ATPase eyenza ukwanda kwenetha kwi-Ca ye-intracellular kunye nefuthe elongeziweyo elithandayo kwi-muscle. Imishishini ye-psychotropic yatshintsha iindlela ze-CNS. Ukusetyenziswa okungapheliyo kwezidakamizwa zokuzonwabisa kunokudibene ne-erectile disysction. Amanye amaarhente achaphazela ukulungiswa, njengokuba kunjalo, iindlela ezingaziwa. Ekugqibeleni, kubalulekile ukuchaza indlela yokwenza imithi nganye ekhankanywe ukuba ibangele ukungabi namandla. Ngaphezu koko, ukuxilongwa kwe-erectile disys functional-induced dispersion must be predicted on the reproducibility of the problem by therapy and the cessation of the problem on the stop.
Ukulimala kwepelvic, ngakumbi ukulimala kwi-perineum kunye ne-pelvic fractures, zidibene ne-erectile disysction. Ukuhlalutya kwezigulane ezenza umgangatho we-eyunivesithi, i-Goldstein ibike ukuba i-35 yezigulane zine-erectile i-dysfunction ebangelwa yintlungu. Ukongezelela, iindlela ze-pathophysiologic zokuphuhliswa kobuthathaka obuthatyathwa ngaphambili. Kwiminyaka yakutshanje kuye kwaqaphela ukuba inani elingafaniyo labaselula abanobunzima be-erectile banembali yeengozi zebhayisikili. Ukuphazanyiswa kwe-prostreombranous urethra, njengoko kuboniswe kwiifractures ze-pelvic ze-pelvic ziye zaxelwa ukuba zihlangene kunye ne-50% yeziganeko ezingenamandla.
Utyando lwe-Urologic lweentlobo ezahlukeneyo luye lwabandakanya kwi-erectile dysfunction. Imisebenzi echazwe ukuba ibangele ukungasebenzi kwe-erectile ibandakanya, i-prostatectomy enkulu, i-retropubic kunye ne-perineal, nokuba i-nerve-sparing okanye ayikho, i-TURP, i-urethrotomy yangaphakathi, i-urethroplasty ye-perineal kunye neenkqubo ze-pelvic exenterative.
Kuze kube yiminyaka eyi-15 eyadlulayo ingakholelwa ukuba yimbangela yengxaki yengqondo kwininzi lamadoda. Abasebenzi abahlukahlukeneyo baye babonisa ubudlelwane phakathi kokudakumba kunye ne-erectile dysfunction. Ubuninzi bokungasebenzi okubambisanayo kunye nentsebenziswano yomtshato kwi-25% yezibini. Kwi-MMAS, iimeko zengqondo ezinxulumene neengxaki ze-erectile zazibandakanya ukudandatheka, umsindo kunye namazinga aphantsi okulawula.
Ngaphandle kweziganeko ezichazwe ngaphambili (iingxaki zeengcambu ze-vascular, endocrinopthies kunye neengxaki zeengqondo) ezingakhokelela ekungabikho amandla ezi zilandelayo ziyakwenza iingxaki ze-erectile:
Ukusilela kwe-Renal: Kuze kube ngu-40% yamadoda aphethwe yintsholongwane engapheliyo ye-renal enye inhlobo ye-dysfunction erectile. Inkqubo eyenziwa yi-impotence kule miphumo mhlawumbe i-endocrinologic (i-hypogonadism, hyperprolactinemia), i-neuropathic (i-nephropathy-induced nephropathy) kunye neengcambu ze-vascular. UHatchchristou uphando ngeendlela zokuziphatha ezingenasigxina ezingabonakaliyo zokungaphumeleli kwintambo engapheliyo yokuhlola nokufumana iziganeko eziphezulu kakhulu zokungasebenzi ngokuthe ngqo. Inendima yokutshintshwa kwethambo ekuphuhliseni ukungasebenzi kwe-erectile kwezi zi gulane. Kwamanye, ukutshintshwa kukuphucula umsebenzi we-renal kwimeko apho izigulane ze-erectile ziphinda ziphuculwe kwaye kwabanye, ingakumbi lawo madoda ayifumene ne-2 transplants, umsebenzi we-erectile ungadlulela phambili.
Iingxaki ze-neurologic: Ukungasebenzi kwe-erectile ye-neurogenic kungabangelwa zizifo ezinjenge-stroke, ubuchopho kunye nesisu somgulane, ukusuleleka kwe-cerebral, isifo se-Alzheimer, i-lobe epilepsy kunye ne-multiple sclerosis (MS). I-Agarwal icacise isiganeko se-85% esingenamandla kwiqela lamadoda emva kokuphazamiseka, ngelixa i-Goldstein ithi i-71% yamadoda ane-MS yachaphazeleka ngxaki zobungqina. Ngoku kutshanje, akubonakalwanga ukuba iAIDS inxulumene ne-autonomic neuropathy engabangela ukungasebenzi kwe-erectile neurogenic.
Izifo zepulmonary: UFletcher waphawula i-30% iziganeko ezingenasiphelo kumadoda anezifo ezingapheliyo zokuphazamiseka kwesifo (COPD), bonke abo babenemizila eqhelekileyo yokupasa kunye neepenile ngokuhlolwa kweDoppler, bebonisa ukuba i-COPD yinto ebalulekileyo ye-etiologic factor.
Iingxaki zesistim: Ngaphandle kwezifo ezikhankanywe ngaphambili (isifo sikashukela, izifo ze-vascular, ukungaphumeleli kwe-renal) ezinye izifo zidibene ne-impotence. I-Scleroderma inokubangela ukuba usebenze nge-erectile ukungabikho komsebenzi ngenxa yesitya se-vasculopathy esincinci esiyibangela. Isifo sesibindi esingasigxina sinxulumene nokukhubazeka kwe-erectile kwi-50% yezigulane ezile ngxaki. esi siganeko sithembele kwi-etiology yesifo sokubandezeleka kwesibindi, isifo sesibindi esinobunxila esineziganeko eziphezulu kunokuba kungekhona utywala.
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