IBoston University School of Medicine
Ukungasebenzi kahle kwe-Erectile kuyinkinga ephawulekayo yezokwelapha. Ucwaningo lwakamuva lwe-epidemiologic lubonisa ukuthi cishe i-10% yamadoda aneminyaka engu-40-70 ine-erectile dysfunction, echazwa njengokuhluleka ngokuphelele ukufeza noma ukugcina ukwakheka okwanele ukusebenza kocansi. I-25% eyengeziwe yamadoda kulesi sigaba sobudala inobunzima obulinganiselwe noma obukhona. Lokhu kuphazamiseka kuncike kakhulu ebudaleni, njengoba ukukhula okuhlanganayo kokulinganisa kokuqeda i-erectile kukhuphuka kusuka cishe ku-22% eneminyaka eyi-40 kuya ku-49% ngokobudala be-70. Nakuba kungavamile kakhulu kumadoda amancane, ukukhubazeka kwe-erectile kusabathinta i-5% -10% yamadoda engaphansi kwe-40. Ukuthola okuvela kulezi zifundo kubonisa ukuthi ukungasebenzi kahle kwe-erectile kuthinta kakhulu isimo somzwelo, ukusebenza komuntu siqu, kanye nekhwalithi yonke yokuphila.
Ukungasebenzi kwe-Erectile kuhlobene ngokuqinile nempilo yomzimba nengokwengqondo. Ezinye zezinto eziyingozi enkulu kukhona isifo sikashukela i-mellitus, isifo senhliziyo, umfutho wegazi ophakeme kanye namazinga we-HDL anciphile. Imithi yesifo sikashukela, umfutho wegazi ophakeme, isifo senhliziyo nokudangala kungenzeka futhi idale ubunzima be-erectile. Ngaphezu kwalokho, kunokwehla okuphezulu kokuwohloka kwe-erectile phakathi kwabesilisa abake batholiswa imisebe noma ukuhlinzwa ngomdlavuza we-Prostate, noma abalimala umgogodla entanjeni yomgogodla noma ezinye izifo zemizwa (isib. Isifo sikaParkinson, i-sclerosis eminingi). Izici zesitayela zokuphila, kuhlanganise nokubhema, ukuphuza utshwala nokuziphatha okuzungezile yizici ezengeziwe zokufaka ingozi. Ukuxhumeka kwengqondo kokungasebenzi kahle kwe-erectile kufaka ukukhathazeka, ukudangala nentukuthelo. Naphezu kokukhula kwaso njalo emadodeni amadala, ukungasebenzi kahle kwe-erectile akubhekwa njengengxenye evamile noma engenakugwenywa ekuguga. Akuvamile (ngamanani amancane angaphansi kwe-5%) ngenxa ye-hypogonadism ehlobene nokuguga, kepha ubudlelwane phakathi kokungasebenzi kahle kwe-erectile kanye nokuncipha okuhlobene nobudala ku-androgen kuhlala kuyimpikiswano.
Ukukhubazeka kwe-Erectile yisimiso esinemiphumela ejulile yengqondo futhi kungaphazamisa ubuhle bomuntu jikelele, ukuzihlonipha kanye nobuhlobo bomuntu siqu. Izilinganiso zokuqashelwa kwesigameko sazo zenziwe phakathi kwamadoda ayizigidi ezingama-10-20. Ngaphezu kwalokho, kukhonjisiwe ukuthi izinkinga ze-erectile zibhekela ukuvakashelwa udokotela ongu-400,000 ngaphandle kweziguli, ukwamukelwa kwesibhedlela i-30,000 kanye nokukhishwa kwemali okwenziwa ngonyaka ngumkhakha wethu wezempilo wama-146 dollar amadola.
Umbiko kaKinsey e-1948 waba isifundo sokuqala ukubhekana nokuvela kokungasebenzi komzimba kubantu bonke. Imiphumela evela kulesi sondlo, esekelwe kwingxoxo eningiliziwe yabesilisa be-12,000, elondolozwe iminyaka, imfundo kanye nomsebenzi, ikhombise inani elikhulayo lokuntula amandla ngeminyaka. Ukuvelela kwalo kukhonjwe kungaphansi kwe-1% emadodeni angaphansi kweminyaka engu-19, i-3% yamadoda angaphansi kweminyaka engu-45, i-7% ingaphansi kweminyaka engu-55 ne-25% ngeminyaka ye-75. Ku-1979, uGebhard uphinde wabuye wafaka idatha ye-Kinsey futhi ku-chort yamadoda angaphezu kwezinkulungwane eziyisihlanu, i-42% yavuma ekuhluphekeni kwe-erectile.
Olunye ucwaningo olwenziwe ezifundweni ezisuselwa ezifundweni ezijwayelekile luye lwahlushwa yizinkinga ezimbili ezinkulu, ukusetshenziswa kwamasampula angameli ngenxa yendlela yokwenza izampuli kanye nenani elingaziwa lensimbi esetshenziswa ocwaningweni. U-Ard, e-1977, ubike ngokuziphatha kocansi kwemibhangqwana ye-161 abashade iminyaka engaphezu kwe-20 futhi waphawula isigameko se-3% sezinkinga ze-erectile. Ku-1978, uFrank wafunda imibhangqwana yevolontiya ye-100, kubikwa ukuthi yayivamile, ayeshadile futhi ekhulile, enobudala obuyiminyaka eyi-37. Amaphesenti angu-40 wabantu abike ubunzima ngokukhishwa kwe-ejaculation. Ngonyaka owodwa, i-Nettelbladt ithola ukuthi i-40% yekhethiwe ekhethiwe, abesilisa abesilisa ocansini (iminyaka yobudala yeminyaka engu-31) babike izinkinga ezithile ze-erectile. Olunye ucwaningo lubike izehlakalo eziguquguqukayo zokulimazeka kwe-erectile, kusuka ku-3-40%. Isifundo se-Baltimore Longitudinal Sokuguga esicaciswe ukukhubazeka kwe-erectile njengoba kukhona ku-8% wamadoda angu-55 iminyaka noma ngaphansi, i-25% yabadala be-65, i-55% yabadala be-75 kanye no-75% wabantu abaneminyaka engu-80 ubudala. ICharleston Heart Study Cohort ibike ngomsebenzi wezocansi kunokuba i-erectile dyfunction. Ibike umphumela we-30% wokungasebenzi phakathi kweminyaka engu-66-69. Ezifundweni zeminyaka engu-80 le namba iphakanyisiwe ku-60%.
Izihloko ezitholwe ezibalweni zezempilo zezempilo nazo ziye zahlaziywa ukuze zisetshenziselwe ubunzima be-erectile. Ekuhlaziyweni kweziguli ezisebenza ngomndeni, uSchein waphawula ukwanda kobunzima be-erectile be-27% ezigulini ze-212 ezineminyaka yobudala eyi-35. I-Mulligan ikhombe ukwanda kwe-6-fold yezinkinga ze-erectile emadodeni aphakathi nendawo anempilo yokuzazisa engeyinhle, kanye nokwanda okuphindwe kabili kwe-40 kwiziguli ezifanayo ngaphezulu kweminyaka engu-70. Eqoqeni lamadoda amadala ase-50 ahlukumezi ukuhlolwa kwezempilo okunempilo nokujwayelekile, uMorley wathola isifo se-27% sokuntuleka kwempilo. Lokhu kutholakala ngokuhambisana neminye imininingwane evela kuMasters noJohn and Slag, efakazela ukuthi amadoda anezimo zezokwelapha anesifo esiphezulu sokungasebenzi kahle kwe-erectile.
IMassachusetts Male Aging Study (i-MMAS) ibiyingxenye esezingeni eliphansi, esekwe ngumphakathi, eyisampula, inhlolovo yezifo ezinhlobonhlobo zokuguga nempilo emadodeni aneminyaka engu-40-70. Ucwaningo lwenziwa phakathi kwe1987-1989, ngaphakathi naseBoston. Izimpendulo zezifundo ze-1290 zahlolwa ngemuva kokuphathwa kwensimbi enemininingwane esekwe emibuzo. Lo msebenzi umelela umsebenzi omkhulu kakhulu kusukela umbiko we-Kinsey ku-1948. Ucwaningo lweMMAS luyehluka ocwaningweni olwenziwe ngaphambilini ngosayizi nokuqukethwe. Kwakuhlanganisa amaqembu amane okuguquguqukayo okungenelela (okuphazamiseka) okungahlobene nokusebenza kocansi: isimo sezempilo nokusetshenziswa kwezempilo, idatha yezenhlalakahle, izici zengqondo nezokuphila.
Yonke imininingwane yaqoqwa ekhaya lale ndaba ngabahloli abaqeqeshiwe. Inqubo ehlukahlukene yezifundo yayifaka ama-gerontologists, ososayensi bokuziphatha, izazi ze-endocrinologist kanye nodokotela abahlukumeza ngokocansi. Umklamo wokutadisha wavumela ukulinganisa okuqondile kwemingcele esemqoka ngenkathi kulawulwa izingxabano ezibalulekile futhi ukuhlonza okuvunyelwe kwezibalo ezibikezelayo eziyingozi. Iqembu lesampula laliseduze kakhulu nabantu jikelele ngangokunokwenzeka. Abantu ababefundile bekuyiqembu eliphilayo ngokukhululeka, elingagcinwanga izikhungo, okuyingxenye yalo kuphela ebeligula futhi lixhumana nohlelo lwezempilo.
Ithuluzi le-MMAS lalinemibuzo ye-23, i-9 yayo ehlobene nekhono le-erectile. Ukuhlolwa okwenziwe nge-erectile potency kwenziwa ngokungahambisani nesimo sokungasebenzi kahle se-erectile. Ucwaningo lwendlela yokucubungula lwaluqhutshwa ukubandlulula amaphrofayili ahlukene we-potency. I-Potency ihlukaniswe amamaki we-4: ayisebenzi, ayinamandla amancane, ayinamandla futhi ayinamandla ngokuphelele.
Izinga eliphelele lanoma iliphi izinga lokungabi namandla kwe-MMAS lalingu-52%, kufaka phakathi i-17% ngokungasebenzi kahle, i-25% ingenamandla futhi i-10% ayinamandla ngokuphelele.Lonke ithuba lokungabi namandla, kwanoma iliphi idigri, eminyakeni engu-40 bekuyi-39% futhi eminyakeni engu-70 I-67%. Ukuphinda kufakwe le datha, kuzobe kunamadoda ayizigidi ezingama-30 e-United States ngenhlobo ethile yokulimazeka kwe-erectile. Izimo ebezihambisana nokungabinamandla kulolu cwaningo zifaka phakathi, isifo sikashukela, umfutho wegazi ophakeme, isifo senhliziyo, isifo sezilonda esingalashwa, isifo samathambo, umuthi wenhliziyo (kufaka phakathi ama-vasodilators kanye nama-antihypertensive agents) kubhema ababhemayo, ama-hypoglycemic agents kanye nokudangala.
Ubudlelwano phakathi kwesifo se-vascular kanye ne-erectile dysfuncion buye babonwa futhi babhalwa kahle. Kuyiqiniso, ukushintshwa ku-vascular hemodynamics (noma ngabe, ukuntuleka kokungalingani noma ukungasebenzi kwe-cosorovenocclusive) kukholakala ukuthi yimbangela evame kakhulu yokungasebenzi kwe-erectile. Isifo esifana nemithambo yegazi esifana ne-myocardial infarction, i-coronary artery bypass surge, izingozi ze-cerebral vascular, isifo se-vasipial kanye ne-hypertension sonke sikhonjisiwe ukuthi sinomthelela ophakeme wokungasebenzi kahle uma siqhathaniswa neningi labantu ngaphandle kwama-vasculopathies. Ukuhlinzwa kwe-Myocardial infarction (MI) kanye ne-corornary artery bypass kuhlobene nobunzima be-erectile ku-64% kanye ne-57% ngokulandelana. Ngaphezu kwalokho, eqenjini lamadoda angenamandla i-130, izehlakalo ze-MI zaziphindaphindwe izikhathi ze-8 emadodeni ane-indile-brachial indices (PBI) kunalabo abane-PBI ejwayelekile (12% vs 1.5%). Emadodeni anesifo se-peripheral vascular (PVD), inani le-erectile dysfunction lilinganisiwe ku-80%. Lesi sibalo singu-10% kumadoda angenawo oxhumene negazi.
Isifo sikashukela esine-vasculopathy ehlobene naso sihlotshaniswa nesilinganiso esiphakeme sokungabinamandla kwayo yonke iminyaka ngokuqhathaniswa nesibalo sabantu bonke. Ukusabalalisa kokuntuleka kwamandla ku-diabetes wonke ama-diary kuye kwacatshangwa phakathi kwe-35 no-75%. Izinkinga ze-Erectile zingase zibe yi-harbinger yesifo sikashukela, lokhu kwenzeka ku-12% yabashukela abayisifo esasanda kutholakala. Isimo sokuntula amandla kwesifo sikashukela sincike eminyakeni yobudala futhi siphezulu emadodeni anesifo sikashukela esiphuthumayo uma kuqhathaniswa nesifo sikashukela sabantu abadala. Kulabo besilisa abanesifo sikashukela abazohlakulela ukungena amandla 505 izokwenza kanjalo phakathi ne-5-10 iminyaka yokuxilongwa kwesifo sikashukela. Uma kuhlanganiswa ukungahambi kahle kwezifo ezithinta abanesifo sikashukela kuvame kakhulu.
Lapho inani lezici ezibeka engcupheni yemisipha (njengokubhema ugwayi, umfutho wegazi ophakeme, isifo senhliziyo, i-hyperlipidemia, kanye nesifo sikashukela) likhula kanjalo nethuba lokungasebenzi kahle kwe-erectile. Lokhu kutholwe kwaqinisekiswa ekuhlaziyeni kweVirag kwamadoda angenamandla e-400, okubonisa ukuthi i-80% yalawa madoda yayinokuhlukumezeka komzimba nokuthi izici zobungozi ze-vascular zazivame kakhulu kuleli qembu kuqhathaniswa nesibalo sabantu bonke.
Ngenkathi ama-androgens abalulekile ekukhuleni nasekuhlukaniseni komgudu wesitho sangasese sowesilisa, ukuthuthukiswa kwezimpawu zobulili zesibili kanye nokuba khona kwe-libido iqhaza labo ohlelweni lwe-erectile kuhlala kungacaci. Ngalesi sikhathi, isimo sokuphenya okufanelekile kwe-hormonal, ukuthi ngabe kuyadingeka yini iphaneli ephelele ye-hormone kuzo zonke iziguli noma ukuthi ukuzimisela kwe-testosterone eyodwa kwakha ukuhlolwa okusebenzayo kuhlale kuyimpikiswano. Impela, ukungaboni ngaso linye kukhona ngokuthi amazinga wama-testosterone amahhala noma aphelele abaluleke kangakanani ekuhlolweni kowesilisa ongenamandla. Noma kunjalo, i-endocrinopathies mhlawumbe ibanga phakathi kwe-3-6% yayo yonke i-erectile dysfunction naleyo endocrinopathies engahle iholele ekungasebenzi kahle ifaka phakathi i-hypogonadism, i-hypothyroidism, i-hyperthyroidism, i-hyperprolactinemia, isifo sikashukela, ukuphazamiseka kwesifo i-adrenal, isifo sesibindi esingamahlalakhona.
Ukudonswa kwe-erectile okuhlobene nezidakamizwa kuvamile futhi nohlu lwemithi olungakhuthaza ukungasebenzi kahle kwe-erectile lubalulekile. Ukungalingani okwenziwe ngemithi kuye kulinganiselwa ukuthi kufinyelela kuma-25% eziguli emtholampilo we-amedical Outpatient. Ama-anthypertensive agents ahlotshaniswa nezinkinga ze-erectile, kuye ngokuthi ama-agent athile ku-4-40% weziguli. Benza ukungabi namandla okuvela kwezenzo ezisezingeni eliphakathi nendawo (i-clonidine), ngezenzo eziqondile ezingeni lobumbano (i-calcium blockers) noma ngokulahla isimiso segazi esimisweni lapho isiguli sithembele kuye ku-mainatin ingcindezi ye-intracorporal eyanele ukuthuthukiswa kwe-penile ukuqina.
Imithi eminingana idala ukungasebenzi ngamandla okusekelwe kwizenzo zabo ze-anti-androgen, ngokwesibonelo ama-estrogens, ama-agonist e-LHRH, abamelene ne-H2, kanye ne-spironolactone. I-Digoxin ingenisa ubunzima be-erectile nge-blockade yephampu ye-NA-K-ATPase ephumela ekunyukeni okuphelele kwe-intracellular Ca kanye nethoni eyalandela ekhulayo emisipha ebushelelezi yokuqina. Imithi ye-psychotropic ishintsha izindlela ze-CNS. Ukusetshenziswa okungapheli kwezidakamizwa zokuzilibazisa kuye kwahlotshaniswa nokukhubazeka kwe-erectile. Ezinye izinhlaka zithinta ukulungiswa, njengamanje, izindlela ezingaziwa. Ekugcineni, kubalulekile ukuchaza indlela esetshenziselwa umuthi ngamunye osolwa ngokubangela amandla. Ngaphezu kwalokho, ukuxilongwa kokungasebenzi kahle kwe-erectile e-dessfunction kumele kubhekwe lapho kuzalwa kabusha inkinga ngokulawulwa kwemithi nokupheliswa kwenkinga ekunqandweni kwayo.
Ukuhlukumezeka kwama-pelvic, ikakhulukazi ukulimala kwe-perineum ne-fractures ye-pelvic, kuhlotshaniswa nokungasebenzi kahle kwe-erectile. Ekuhlaziyeni kweziguli ezethula emnyangweni we-universities, i-Goldstein ibike ukuthi i-35 yeziguli zine-erectile ukungasebenzi okubangelwa ukuhlukunyezwa. Ngaphezu kwalokho, izindlela ze-pathophysiologic zokwakhiwa kokungakwazi ukusebenza okunjalo bezilotshwe ngaphambilini. Eminyakeni yamuva kuye kwaqaphela ukuthi inamba engahambisani nezinsizwa ezinenkinga erectile inomlando wezingozi zamabhayisikili. Ukuphazamiseka kwe-urethra ye-prostatomembranous urethra, njengoba kubonakale ekuwohlokeni kwe-pelvic e-svere kubikwa ukuthi kuhlobene nesikhathi sokufika kokungabi namandla kwe-50%.
Ukuhlinzwa kwe-urologic kwezinhlobo ezahlukahlukene kuye kwagcizelela ukungasebenzi kahle kwe-erectile. Ukusebenza okubikwe ukuthi kubangela ukungasebenzi kahle kwe-erectile kufaka phakathi, i-radical prostatectomy, i-retropubic kanye ne-perineal, ngabe i-nerve-sparing noma cha, i-TURP, i-urethrotomy yangaphakathi, i-perineal urethroplasty kanye nenqubo ye-pelvic exenterative process.
Kuze kube yiminyaka eyi-15 edlule ukungabi namandla okukholelwa ukuthi kungumphumela wezinkinga zengqondo ngobuningi bamadoda. Izisebenzi ezihlukahlukene zibonise ubudlelwane obuphakathi kokucindezeleka kanye nokungasebenzi kahle kwe-erectile. Ukuba khona kwe-erectile dysfunction kuhlangene ne-discord yomshado ku-25% yemibhangqwana. Ku-MMAS, izici ze-psycholgic ezihambisana nezinkinga ze-erectile zifaka ukudangala, ulaka kanye namazinga aphansi okubusa.
Ngaphandle kwezici ezivele zichaziwe (izici zobungozi be-vascular, i-endocrinopthies nezinkinga zengqondo) ezingase ziholele ekuthini zisebenze lezi zimo ezilandelayo zingabanga izinkinga ze-erectile:
Ukungaphumeleli kwe-Renal: Kuze kube ngu-40% wamadoda ahluleka ukuhluleka kwezintuthwane ezingapheli anenye uhlobo lokungasebenzi kahle kwe-erectile. Umshini umphumela wokungabi namandla kwalokhu kuphazamiseka kungenzeka ubumbeke kakhulu, obandakanya i-endocrinologic (hypogonadism, hyperprolactinemia), i-neuropathic (i-nephropathy yesifo sikashukela) kanye nezici zemithambo yegazi. UHatzichristou uphenye ubuhlakani bemithambo esezindlini zamadoda ezihluleka ukuqina kwezinso okungaphumeleli futhi ongahlolanga kahle we-hemodynamic futhi bathola isehlakalo esiphakeme sokungasebenzi kahle kwe-Corporovenocclusive. Indima yokudluliselwa kwezinso ekwakheni ukungasebenzi kwe-erectile kulezi ziguli iyahluka. Kwezinye, ukufakelwa kuthuthukisa umsebenzi wezinso kuze kufike lapho iziguli erectile zisebenza khona futhi kwezinye, ikakhulukazi lawo madoda ayethole i-2 transplants, umsebenzi we-erectile ungahle uqhubeke futhi.
Ukuphazamiseka kwe-Neurologic: Ukungasebenzi kahle kwe-Neurogenic erectile kungahle kudalwe yiziphazamiso ezinjengokuthi, unhlangothi, ubuchopho kanye nesigaxa somgogodla, ukutheleleka kwengqondo, isifo i-Alzheimer's, isithuthwane sethambo lesifo sokuqina kwenhliziyo kanye ne-multiple sclerosis (MS). U-Agarwal ucaphune isigameko sokungabi namandla kweqembu lamadoda kulandela ukuhlaselwa yisifo sohlangothi, kanti uGoldstein waphawula ukuthi i-85% yamadoda ane-MS athinteka ebunzimeni be-erectile. Muva nje, kuye kwaqaphela ukuthi i-AIDS ihlobanise neuropathy yokuzimela engabangela ukungasebenzi kwe-erectile neurogenic.
Izifo ze-Pulmonary: UFletcher waphawula ukuthi i-30% isenzekisa ukungabinamandla emadodeni anesifo esingamahlalakhona (i-COPD), sonke esinokuphazamiseka okujwayelekile kokujula nokubuthakathaka ngokuhlolwa kwe-Doppler, siphakamisa ukuthi i-COPD yayiyisici esiyisisekelo se-etiologic.
Izinkinga zesistimu: Ngaphandle kwezifo ezishiwo kakade (isifo sikashukela, izifo ze-vascular, ukwehluleka kwenqenqemeni) ezinye izinkinga zihlobene nokungabi namandla. I-Scleroderma ingahle ibangele ukungasebenzi kahle kwe-erectile ngenxa ye-vasculopathy yomkhumbi omncane oyibangela. Isifo sesibindi esingamahlalakhona sihlotshaniswa nokukhubazeka kwe-erectile kuze kufike ku-50% yeziguli ezinale nkinga. lesi sigameko sincike ekutheni i-etiology ye-dysfunction isifo, isibindi sesibindi esinesidakwa esinomthelela ophakeme kunezingekho izidakamizwa.
;