Ukusebenza kwe-Erectile: Ukubuyekezwa Kwezinketho Ezigcwele Zokulashwa Okuphelele Komphumela Omuhle (2019)

Source: I-Journal of restorative Medicine, Umqulu 8, inombolo 1, 16 kuFebhuwari 2019

About the Author: I-Rezler, uKathryn

UKUQALA

I-Erectile dysfunction (ED) ijwayelekile ngokuguga. Phambilini ukwelashwa kwe-ED kunikelwe ikakhulukazi ngabachwepheshe be-urologist, kepha ukuvunywa nokusetshenziswa kabanzi kwama-phosphodiesterase inhibitors kunikeze usizo odokotela usizo oluphuthumayo ukunikezela ukwelashwa kwe-ED okuhlosiwe. Yize izivivinyo zemitholampilo ezinkulu, ezinamabala amaningi zibonakalise ukusebenza ngempumelelo nokuphepha ngalezi zidakamizwa, azisebenzi ku-30-35% yamadoda, zingadala imiphumela emibi, futhi zingayithuthukisi i-pathology eyisisekelo. Ukuqonda kahle i-erectile physiology kanye nezimbangela ze-ED kanye nohlelo oluphelele lokwelashwa olubhekelela zonke izici ezifakwayo kungenzeka lusebenze kangcono kunokuphathwa kwemithi futhi lungathuthukisa izici zempilo yengqondo neyomzimba ngaphandle kwezinkinga ze-erectile.

ISINGENISO

I-Erectile dysfunction (ED) - ukungakwazi ukuthuthukisa kanye nokugcina i-erection firm eyanele ukungena - kuvamile ngokuguga. Cishe i-40% yamadoda aneminyaka engama-40 no-70% yamadoda aneminyaka engama-70 anhlobo ethile ye-ED.1 I-ED ihlotshaniswa nezimo eziningi zomzimba, ingaba yi-harbinger yesifo se-metabolic noma se-vascular, futhi ithinta impilo ye-psychosocial. I-Phosphodiesterase hlobo 5 inhibitors (PDE5i) yiyona ndlela yokuqala evamile yokwelashwa kwe-ED. Izilingo ezinkulu zomtholampilo ezinkulu nezinhlobonhlobo zikhombisile ukusebenza nokuphepha ngalezi zidakamizwa; kodwa-ke, azisebenzi ku-30- 35% weziguli,2 kungadala imiphumela emibi, futhi ungayithuthukisi i-pathology eyisisekelo. Ukwelashwa okuphelele kwe-ED okugxila kuzo zonke izici ezineqhaza kungasebenza ngempumelelo ukwedlula ukuphathwa kwemithi futhi kungathuthukisa izici zempilo yengqondo nangokomzimba ngaphezu kwezinkinga ze-erectile.

UKUBUYEKEZA UBUCHWEPHESHE KANYE NESIFUNDO SEZENDALO

I-ED ivela kuma-multifactorial, izindlela eziyinkimbinkimbi ezibandakanya amasistimu wezinzwa, wemithambo yegazi, ne-endocrine. Ukubuyekezwa okuyisisekelo kwe-anatomy kanye ne-physiology ye-erections kuzonikeza uhlaka lokuqonda i-pathophysiology kanye nomqondo ngezinketho zokwelashwa (Umfanekiso we-1). Ukwakheka kwephenisi kuqukethe amasilinda amabili we-vascular izicubu (i-corpora cavernosa) egijima ubude beshibe le-penile kanye ne-corpus spongiosum ezungeze irethra. Izicubu zePenile zangaphakathi kwe-autonomic (enozwela futhi parasympathetic) kanye somatic (sensory kanye motor) sohlelo lwezinzwa olungemuva. Izinzwa ezinesihawu ziqhamuka ku-T11-L2 futhi zilwa ne-erectile, zilawula ukumiswa kwemvelo kanye ne-detumescence. Izinzwa ze-Parasympathetic zivela ku-S2-S4 futhi ziyi-pro-erectile. Izinzwa ezizwelayo nezikhubazayo ziyahlangana ukwenza izinzwa ezi-cavernous ezingena kwi-coora cavernosa, i-corpus spongiosum, ne-glans penis, ezilawula ukuhamba kwegazi ngesikhathi sokudalwa. I-pudendal nerve inikezela umuzwa kuwo wonke umsebenzi we-pelvis nowemoto kuwo wonke ama-sphincters, phansi we-pelvic kanye nemisipha yokuqina.

I-Anatomy yesitho sangasese esibonisa izakhiwo ezinkulu, imithambo yegazi nezinzwa.

Umfanekiso 1:

I-Anatomy yesitho sangasese esibonisa izakhiwo ezinkulu, imithambo yegazi nezinzwa.

Imithambo ye-pudendal yangaphakathi ihlinzeka ukugeleza kwegazi eweni, kuhlanganiswe emithanjeni ye-bulbourethral, ​​dorsal, and cavernosal. I-bulbourethral artery idlula kwi-penile ejulile (i-Buck) fascia, ihlinzeka nge-bulb ye-penis ne-penile urethra. I-dorsal artery ihamba phakathi kwe-dorsal nerve ne-dorsal vein ejulile enikeza amagatsha angama-circflex ahambisana nemithambo ye-circflex enamagatsha asesigabeni kuma-glans. I-penile ejulile noma i-cavernosal artery ingena ku-corpus cavernosum endaweni yendawo futhi igijimisa ubude be-penile shaft, ihlinzeka ngemithambo ekhethekile ye-helicine.

Ukugqugquzela ucansi kuvusa izinzwa zepasympathetic ukukhipha i-acetylcholine. Ngaphakathi kwamaseli we-endothelial lining penile artery, i-nitric oxide synthase (NOS) ifaka i-oxidation ye-L-arginine ku-nitric oxide (NO) ne-L-citrulline. AKUKHO i-activates guanylate cyclase ku-coora cavernosa ne-spongiosum, yona ekhulisa i-cyclic guanosine monophosphate (cGMP) okuholela ekuphumuzeni kwemisipha ebushelelezi, i-vasodilation, kanye nokwenyuka kokuphuma kwegazi. Ukugcwaliswa okusheshayo nokwanda kohlelo lwe-sinusoidal kubangela ukubanjiswa kwegazi ngokuqhamuka kwe-venous plexuses kanye ne-tunica albuginea, okuholele ekuqothulweni okuphelele kokuqhuma kwe-venous. Umfutho we-Intracavernosal ufinyelela ku-100 mmHg ekukhulweni okugcwele. Imisipha ye-Ischiocavernous icindezela i-cavernosa egcwele igazi njengezivumelwano zemisipha ye-perineal eyenza ingcindezi yokugcina ifinyelele kumakhulu amaningana ama-mmHg. Ngemuva kwe-ejaculation, ukukhululwa kwe-neurotransmitter kuyaphela ngenxa yokuzwela okuzwela kwe-nerve kanye ne-phosphodiesterase enzyme kubhidliza i-cGMP okuholela ekwembeseni komzimba nokuphefumula (Umfanekiso we-2).

I-phologyology yama-erections.

Umfanekiso 2:

I-phologyology yama-erections.

Ach, acetylcholine; i-cGMP, i-cyclic guanosine monophosphate; CHA, nitric oxide; PDE, phosphodiesterase; I-SNS, uhlelo lwezinzwa olunozwela.

UKUCHWEPHESHA INDAWO YOKUGCINA

Ukuhlolwa ngokuphelele kwe-ED kudinga umlando ophelele, ukusetshenziswa kwamaphepha emibuzo aqinisekisiwe, ukuhlolwa ngokomzimba, nomsebenzi welebhu. Ukulingisa, njenge-duplex doppler ultrasound, i-penile arteriography, ne-MRI kufanele kwenziwe ngudokotela wezifo futhi agcinelwe ukungenelela kokuhlinzwa okungenzeka.

UMLANDO

Ukuthatha umlando ophelele kunikeza ithuba lokuthola zonke izimbangela / izinto ezinegalelo ezihlobene ne-ED. Ngokuphathelene nezici zengqondo, ukubuza mayelana nezingcindezeli zamanje nezinkinga zobudlelwano kubalulekile.

Ukulindeka kwesithombe sobulili kanye nokulindelwa imvamisa yezocansi kuvame ukunganakwa izihloko lapho kuthathwa umlando wezocansi, kepha kube nomthelela omkhulu ukusebenza kocansi. Imiphumela evela ekuthuthukisweni nasekuqinisekisweni kwe-Male Genital Self-Image Scale (MGSIS) ehlola abesilisa abaneminyaka eyi-18-60 yathola ukuthi amadoda anezithombe ezingcono zesitho sangasese abikwa ukuthi abaphansi kwe-ED futhi ama-20% amadoda awenelisekile ngosayizi wawo wepenisi.3 Amadoda anezithombe ezingezinhle zokuzala angazibuza ukuthi usayizi wepipi wawo uqhathaniswa kanjani namanye amadoda. Idatha ka-Alfred Kinsey emadodeni angama-2500 ibike ukuthi ubude obujwayelekile be-penis penis buyi-1 inches ne-penis emile emaphakathi njengamasentimitha ama-4-5. Kuyamangaza ukuthi amadoda athambekele ukungabukeli phansi usayizi wawo wepenja uma kuqhathaniswa nesilinganiso sangempela.4

Ukuxoxa ngokulindelwe mayelana nokuvama kokuya ocansini kufanelekile kumadoda ane-libido ephansi, imizwa yokungafaneleki kwezocansi, noma ilukuluku ngemvamisa yabo yezocansi uma iqhathaniswa namanye amadoda. Izibalo eziphathelene nemvamisa yokuhlangana ngocansi zikhawulelwe. Ucwaningo olulodwa lwe-AARP lwabesilisa nabesifazane abalinganiselwa eminyakeni engama-1670 ubudala lubike ukuthi ama-45% amadoda aseminyakeni engama-41, ama-50% amadoda aseminyakeni engama-24, kuthi ama-60% amadoda aseminyakeni engama-15 ubudala alala nobusuku kanye ngesonto (ebhala kabusha lezi zibalo - Ama-70% amadoda abaseminyakeni yama-59, ama-50% kuma-76s wawo, kuthi ama-60% wamadoda aneminyaka engama-85 ahlanganyele ocansini kaningi kanye ngesonto).5 I-International Society for Sexual Medicine (ISSM), ibika imiphumela evela eKingsey Institute's 2010 National Survey yezocansi kanye nokuziphatha, yaphawula ukuthi ngaphansi kwengxenye yamadoda ashadile aneminyaka engama-25 kuya kwengama-49 enza ucansi amahlandla ambalwa ngenyanga kuya ngesonto, okwakunguye inani eliphakeme kakhulu kunoma yisiphi isigaba seminyaka.6 Olunye ucwaningo olushicilelwe yi-ISSM luhlola abesilisa nabesifazane abangaphezu kweminyaka engama-50 lubike ukuthi ngama-20-30% kuphela amadoda nabesifazane abasala benza ucansi phakathi kwabo babe ngama-80s.7

Ukusetshenziswa kwezithombe zobulili ezingcolile kuyisihloko esingase singakhululeki ukuthi odokotela baxoxe neziguli zabo zesilisa. Noma ukuxilongwa kokulutha kwezithombe zobulili ezingcolile kuyimpikiswano, kunobufakazi obukhulayo obuxhumanisa ukusetshenziswa kwezithombe zobulili ezingcolile ngomthelela wokwaneliseka okuhlanganyelwe ngokobulili, injabulo yomshado nobudlelwano, kanye nokungasebenzi ngocansi kubandakanya i-libido ephansi ne-ED.8-11 Izithombe zocansi ze-Intanethi zinikeza ama-movie angenamkhawulo kanye nefomethi yevidiyo efunwayo engase ivuse inkanuko yezocansi, yenze kube nzima ngamadoda ukuguqukela kubalingani bangempela bempilo.12 Alikho ithuluzi lokuhlola eliqinisekisiwe lokubona ubunzima obuhlobene nezithombe zobulili ezingcolile kubandakanya i-ED. Ngemuva kokubuza ngokuvama kokusetshenziswa kwezithombe zobulili ezingcolile, abahlinzeki bezokunakekelwa kwempilo kufanele babuze ngekhono lokufeza nokuligcina lakhiwe ngesikhathi sobudlelwano bezocansi nobunezitho zangasese ngaphandle kokusebenzisa izithombe zocansi noma ukukhumbula. Uma ukusetshenziswa noma ukukhumbula izithombe zobulili ezingcolile kuyadingeka ukukhiqiza ukwakheka okwanele, i-ED eyenziwe nge-porn kungaba yinkinga.

IMIBUZO EBALULEKILE

Amaphepha emibuzo aqinisekisiwe ayasiza ekuhlolweni kwe-ED. Umbuzo osetshenziswa kakhulu ekusetshenzisweni komtholampilo nasekucwaningeni okushicilelwe yi-15-nto International Index ye-Erectile Function (IIEF-15), eqinisekisiwe ngezilimi ezingama-32.13 Uhlobo olufushane, i-IIEF-5, noma i-imibuzo yezempilo yezocansi ethi Inventory for Men (SHIM) nayo ingaba wusizo ekuxilongeni nasekubhekeni ukusebenza ngempumelelo kwemithi.14,15

UVIVINYO LOKUHLELA

Ukuhlolwa ngokomzimba kufanele kufake ukuhlolwa kwe-penile kanye ne-testicular, amandla we-pelvic floor kwemisipha (ngokuhlolwa kwedijithali), umfutho wegazi, ubufakazi besifo senhliziyo, ukuphakama, isisindo, kanye nokujikeleza okhalweni.

UMSEBENZI

Ngokusekelwe emlandweni nasekuhlolweni ngokomzimba, ukuhlolwa kwelabhoratri kungafaka amaphaneli aphelele we-metabolic kanye ne-lipid, i-insulin esheshayo, i-hemoglobin A1C, umaki wokulimala onjenge-hsCRP, inani eliphelele nelingamahhala le-testosterone, ukuhlolwa kwe-thyroid, futhi, emadodeni amancane ane-hypogonadism esolwayo, i-luteinizing hormone ne-prolactin .

IZAKHONO NAMAQINISO AQINILE

Izimbangela kanye nezinto ezineqhaza ku-ED zingadlula. Lokhu kufaka izindaba ezithinta ingqondo, izinkinga zemizwa, ukusetshenziswa kwezithombe zocansi ngokweqile, ukuphazamiseka kwe-endocrine, imiphumela emibi yemithi kanye nezinguquko emithanjeni.

I-PSYCHOGENIC

Ukucindezeleka okukhulu, ubunzima bezobudlelwano, ukudangala, ukukhathazeka, kanye nokuxineka kwangemva kokuxineka konke kungaba nomthelela ku-ED. Ukukhathazeka ngokusebenza, okokuqala okuchazwe ngabakwaMasters noJohnson ngo-1970,16 ukungakwazi ukufeza ubumbano ngenxa yokuhlangenwe nakho okwedlule nge-ED. Ukungasebenzi ngocansi, ikakhulukazi i-ED kanye nokwehla kwesifiso sobulili, kukhula kakhulu kuma-veteran angabesilisa ane-post-traumatic stress disorder.17 I-Psychogenic ED ivame ukwenzeka phakathi kobulili obuhlanganyelwe nomsebenzi ojwayelekile we-erectile ngesikhathi sokushaya indlwabu. Ukuqala kungenzeka kube ngesikhashana, kuhambisane nengcindezelo efana nokulahlekelwa ngumsebenzi, ukushona kwesihlobo, noma izinkinga zezezimali. Ama-ectitions we-nocturnal noma ekuseni avamile.

NEUROLOGICAL

Uhlelo lwe-limbic, kufaka phakathi i-amygdala; i-hippocampus; kanye ne-gyri and dingate and gingri, kungenye yezindawo ezindala kakhulu zobuchopho ezivamile kuzo zonke izilwane ezincelisayo. Lesi sifunda ubuchopho silawula imizwa nemizamo yokugwema izinhlungu nokufuna injabulo. Ucwaningo lukhombisa ukuthi isisusa esibonakalayo esivumayo sobulili senza kusebenze i-amygdala ne-hypothalamus kakhulu emadodeni kunabesifazane.18 Okokufaka okuvela ku-amygdala kuhamba ku-ventral striatum, ingxenye enkulu ye-basal ganglia esebenza njengengxenye yohlelo lomvuzo. Ama-nucleus accumbens ngaphakathi kwe-ventral striatum aqukethe iqoqo elikhulu lama-dopaminergic neurons futhi abhekwa njengesikhungo sokujabulisa ingqondo. Ukubonisa isiginali ye-Dopamine kudlala indima enkulu ekuvuseleleni kwezocansi kanye nasekugqugquzeleni. Ukwenza kusebenze ama-dopamine receptors ku-lumbosacral parasympathetic nerves yomgogodla kusiza ama-erections.19

Izimo eziphazamisa i-dopamine signaling ejwayelekile noma i-neurotransication, noma ezingalimaza uhlelo lwezinzwa oluphakathi, ngokwesibonelo, isifo sikaParkinson, i-sclerosis eminingi, isifo sikashukela noma isifo sohlangothi, naso singadala i-ED. Ukulimala kwezinzwa ze-Cavernous ngesikhathi sokuqina kwe-prostatectomy kuholela ku-ED kumadoda angaphezu kuka-50%.20 Ukugibela ibanga elide kungacindezela i-pudendal nerve nemithambo yegazi phakathi kwesihlalo sokudabuka ne-pubic symphysis, kunciphisa ukuhamba kwegazi nomoya-mpilo ku-penis.21,22 Abahamba ngamabhayisekili bangathola ubunzima besikhashana be-ED nobunzima besitho sangasese sangasese; noma kunjalo, kungenzeka bangabi nengozi enkulu ye-ED. Imiphumela yocwaningo lwakamuva lwabesilisa abangama-5000 yabasubathi yabonisa ukuthi abahamba ngamabhayisekili kungenzeka nje babhekane ne-ED njengabadobi nabagijimi.23

UKUSETYENZISWA PORNOGRAPHY

Yize ukusetshenziswa kwezithombe zobulili ezingcolile kungabhekwa njengokwamukeleka emphakathini futhi kuvamile, ubungozi bezempilo bokusebenzisa njalo abaziwa. Izithombe zocansi ze-Intanethi zinikeza okuyize okubonakalayo okungenamkhawulo okubonisa ukuthi i-Coolidge Effect, into yemvelo ebonakalayo ezilwaneni zesilisa lapho zibonisa intshisakalo evuselelwa uma yethulwe abalingani abahlukene abathandayo kwezocansi.24 Lokhu kuhlinzeka ngenzuzo yokuziphendukela kwemvelo enika amandla owesilisa ukuba afake izinsikazi eziningi. Isisusa sobuhlakani bobuciko be-Novel kuvusa ukuvusa okuqinile, ama-erections ama-firmer, nokukhipha ngokushesha isidlidliza ngesidoda esikhulayo kanye nokukhiqizwa kwamaduna.25-27

Ukusetshenziswa ngokweqile kwezithombe zocansi ze-inthanethi kungathonya i-neuroplasticity.28 Zonke izidakamizwa zokuhlukumeza kanye nokuziphatha okuluthayo, njengokudlalwa kwe-Intanethi nokudla ngokweqile, kuthinta indlela ye-mesolimbic dopamine indlela ne-nucleus accumbens.29 I-Novelty ikhuthaza ukunyuka kwe-dopamine kuma-nucleus accumbens, okubangela ukukhishwa kweprotheni yokuphendula ye-cAMP element-binding protein (CREB). I-CREB ilawula ukuvezwa kofuzo kwe-dynorphin, iprotheni ebambezela ukukhishwa kwe-dopamine, inciphise uhlelo lomvuzo.30 Lokhu kukholakala njengokuyisisekelo sokuvumela ukubekezelela njengoba amanani andayo emithi noma yokuziphatha kudingeka ukunqoba inani elikhulayo le-CREB. Lapho kuvinjelwa, ukuncishiswa kwe-dopamine kukhuthaza i-anhedonia, ngokunokwenzeka ukusetha ukuncika kumuthi noma ekuziphatheni.

Ngaphezu kwe-CREB, iDeltaFosB ikhishwa ngokugcwala okuphindaphindiwe kwe-dopamine kwama-nucleus accumbens. I-DeltaFosB ikhuthaza ukuqiniswa okuhle kokuziphatha okuluthayo ngokucindezela ukukhululwa kwe-dynorphin futhi kukhulise ukuzwela komuthi noma ekuziphatheni. I-DeltaFosB iyaphikelela isikhathi eside, okuholela ekutheni abanye ochwepheshe abayimilutha bayibize ngokuthi “umshini wokuguqula umlutha.”31 Le ndlela ichaza ukuthi ukusetshenziswa kwezithombe zobulili ezingcolile okuphindaphindwe kaningi, njengezinye izinto eziluthayo, kubangela ukwanda kwesifiso kanye nokwehliswa komhlaba kwe-dopamine receptor, ukusetha umsebenzisi ukuba abe ngumjikelezo wokuxhaxha, wokulangazelela nokuguguleka komandla.32

ISIVIVINYO

Ngaphandle kokuba yisidingo sokukhula nokukhula kwe-penis kanye nokwenza ngcono i-sex drive, i-testosterone ilawula i-erectile physiology ngamamishini amaningana. I-Testosterone ikhuthaza ukwakheka kwezinzwa okuhle, ubuqotho, nokusebenza, ikakhulukazi izinzwa ze-cavernous.33 Izifundo zezilwane nezabantu ziphakamisa ukuthi i-testosterone ithuthukisa i-nitric oxide synthase gene expression kanye NO ukukhiqizwa emithanjeni ye-penile, kudingekile nge-vasodilation.34,35 I-Testosterone kungenzeka iguqule umsebenzi we-PDE5 njengoba kufakazelwa izifundo zezifundo zezilwane ezibonisa up-umthethonqubo wenkulumo ye-PDE5 nge-testosterone supplementation.36,37

Amazinga aphansi we-testosterone yamahhala ne-bioavava (kepha hhayi ephelele) ahlotshaniswa nokungasebenzi kahle kwe-erectile.38 Yize izinga le-testosterone elidingekayo ukufezekisa nokugcina ama-erections lingaziwa, inani elincane libonakala lidingeka emsebenzini we-erectile.39,40 Ukungezelelwa kwe-testosterone kungenzeka kungathuthukisi i-ED kuwo wonke amadoda; noma kunjalo, ezinye izifundo zikhombisile ukuthi i-testosterone therapy ingaba lusizo futhi inike amandla ama-PDE-5 inhibitors ukuthi asebenze kangcono.41,42

Abanye ababhali babhale amazinga aphezulu we-estradiol emadodeni noma isilinganiso esiphakeme se-estradiol-to-testosterone esihambisana ne-ED.43-45 I-Aromatase inhibitors ivimbela ukuguqulwa kwe-testosterone ibe yi-estradiol futhi kungangeza inani eliphelele ne-bioavaible testosterone emadodeni asebekhulile abane-hypogonadism emincane ngenkathi behlisa kancane amazinga e-estradiol.46 Njengamanje, abukho ubufakazi bokuthi i-aromatase inhibition ithuthukisa umsebenzi wobulili futhi akukho zincwadi zokuxhasa ukusetshenziswa kwe-aromatase inhibitors ye-hypogonadism.47 Ngaphezu kwalokho, ezinye izifundo zithole isilinganiso phakathi kwe-estradiol ne-testosterone ayihlobene nomsebenzi we-erectile noma isifiso sobulili.48,49

I-secretion ephezulu ye-prolactin iyimbangela engajwayelekile ye-testosterone ephansi ne-ED. Lokhu kungabangelwa i-pituitary tumor (prolactinoma), insangu, noma umuthi onjengama-amphetamines, ama-H2 blockers, ama-risperidone, ama-SSRI, ama-MAO inhibitors, namanye ama-anticepressants angama-triceclic. I-Prolactin kufanele ilinganiswe kuphela ezimweni zesifiso esiphansi sobulili, i-gynecomastia, kanye / noma inani eliphelele le-testosterone elingaphansi kwe-4 ng / mL (400 ng / dL).50

Kokubili i-hypothyroidism ne-hyperthyroidism kungaholela ku-ED futhi ku-ED kuvame kakhulu emadodeni ane-dysthyroidism kunakulawulo.51 Ukwelashwa kwe-hypothyroidism ne-hyperthyroidism kungathuthukisa i-ED.52 Ngakho-ke, kunconywa ukuthi kuhlolwe ukungasebenzi kahle kwe-yegilo emadodeni ethula ne-ED.

KAKHULU

Impilo efanelekile ye-vascular ibaluleke kakhulu ekufezeni nasekugcinweni kwama-erections. Ukungasebenzi kwamathambo kubangela ama-70-80% we-non-psychogenic ED emadodeni amadala. Ngoba i-atherosclerosis of coronary, carotid, cerebral, noma i-peripheral artery ingadala kuphela izimpawu uma usuhambile, u-ED kungaba uphawu lokuqala lwesifo se-vascular generalized.53,54 Esivivinyweni Sokulwa Umdlavuza Wokuvikela Umdlavuza kanye nokuvimbela, cishe amadoda ayizi-10,000 ahlelwa ngengalo ye-placebo njalo ngemuva kwezinyanga ezintathu futhi alandelwa isifo se-ED nesenhliziyo kusuka ngo-1994 kuya ku-2003. U-ED wayeyisici esikhulu sengozi yemicimbi yenhliziyo yesikhathi esizayo njengokubhema nomlando womndeni we ukuhlaselwa yinhliziyo.55 Ukuba khona kwe-ED kungaphinde kube yisibikezeli sokufa okudala imbangela.56 U-ED uhlanganyela ngezici ezifanayo eziyingozi njengesifo senhliziyo - umfutho wegazi ophakeme, ukuntuleka kokuzivocavoca, ukudla okungenampilo, ukubhema, isifo sikashukela ne-hyperlipidemia. Indlela engaphansi ye-ED ehlobene nemithambo ifaka ukungasebenzi kahle emzimbeni.57,58 Ukulawulwa kwe-vasodilation kungukusebenza kwe-nitric oxide (NO) ekhishwe amaseli endothelial. AKEKHO oqala ukukhiqizwa kwe-cGMP ebangela ukuphumula kwemisipha ebushelelezi kanye nokuqina kwamathambo emithanjeni ye-corpus cavernosum. Ukungasebenzi komzimba kwe-Endothelial kwandisa ingozi ye-ED, noma ngabe abukho ubufakazi bomtholampilo besifo senhliziyo.59,60

IMIPHUMELA YOKUCHWEPHESHELA

Ama-ejenti amaningi wemithi angaba nesandla ku-ED ngokuthinta ama-neurotransmitters, ama-hormone, umsebenzi wezinzwa, noma ukugeleza kwegazi. Yize kungewona uhlu oluphelelayo, okubangwa okuvamile kufaka phakathi ama-antidepressants (ikakhulukazi ama-SSRI afana ne-fluoxetine, i-sertraline, i-citalopram), i-anxiolytics, i-CNS depressants, kanye nama-revisol izicubu (lorazepam, cyclobenzaprine). I-Diuretics (HCTZ, spironolactone, triamterene, furosemide) kanye ne-antihypertensives kanye ne-beta-blockers (clonidine, enalapril, metoprolol) nayo ihlala ifaka isandla ku-ED.

ISIHLOKO:

Kubalulekile ukwakha uhlelo oluphelele lokwelashwa lwe-ED, ngoba kungenzeka lusebenze kangcono kunokusebenzisa i-ejenti eyodwa ukubhekana nezimpawu kuphela.

UKUXHUMANA KOMNYANGO WE-PSYCHOSEXUAL

Ukudluliselwa kokwelashwa kokuqonda kokuziphatha, ukuphathwa kwengcindezi, noma ukwelashwa kombhangqwana kungahle kulungele amanye amadoda ane-ED. Ubudlelwano be-causal obuphakathi kokudangala ne-ED abukacaci futhi kungenzeka bube buzwe.61 Eqinisweni, isivivinyo esisodwa esilawulwa ngokungahleliwe (i-RCT) samadoda ayi-152 anesifo sokudideka sobumnene kuya ku-ED futhi sakhombisa ukuthuthuka kumadoda anikezwe i-sildenafil lapho i-ED yabo ithuthuka.62 I-ED ebangelwa ukukhathazeka kokusebenza noma ukuphatheka kahle iphathwa kahle ngokwelashwa kokuziphatha kwengqondo yomuntu ngamunye, ukwelulekwa ngobuhlobo, noma ukusebenza nodokotela oqinisekisayo wobulili. Kukhona nobufakazi bokuthi ukwelashwa kweqembu kungathuthukisa ukusebenza kwe-erectile. Ukubuyekezwa kweCochrane kwezilingo eziyi-11 zeklinikhi (eziyisishiyagalolunye zazo zenziwa ngokungahleliwe), kwaphetha ngokuthi ukwelashwa kweqembu okugxilwe kulo kwakusebenza kangcono kunokulashwa kwe-ED. Ukuhlaziywa kwe-meta-ukuhlolwa kokuqhathanisa ukwelashwa kweqembu kanye ne-sildenafil citrate dhidi sildenafil kuphela, kutholakale ukuthi amadoda athola ukwelashwa kweqembu kanye ne-sildenafil akhombise ukuthuthuka okukhulu kokuhlangana okuphumelelayo futhi ayengaphansi kwalabo abathola i-sildenafil kuphela yokuyeka. Ukwelashwa kweqembu kuphinde kwathuthukisa kakhulu i-ED ngokuqhathaniswa ne-sildenafil citrate kuphela.63

UKUFINYELEKA KUSUSELEKELWE PERNOGRAPHY KUSUSELA

Ukuguqula i-ED okubangelwa ukusetshenziswa njalo kwezithombe zobulili ezingcolile kudinga isiguli ukuba sisuse konke ukubuka izithombe zobulili ezingcolile, indawo yokubuka ezocansi, ukukhumbula izithombe zobulili ezingcolile, kanye nakho konke ukugqugquzela ezocansi. Lokhu kuvumela ukubuyisa amandla avusa inkanuko yobulili ne-erectile nabalingani bempilo yangempela. Yize isikhathi soku "ukuqala kabusha" ubuchopho ngokugwema ukubuka izithombe ezingcolile zingaziwa, isazi somlutha wobulili ezingcolile uGary Wilson sibonisa okuhlangenwe nakho komtholampilo futhi izinkundla ezikwi-inthanethi zikhombisa ukululama okusheshayo kwabesilisa iminyaka engaphezu kwengu-50, siphakamisa ukuthi izinyanga ezi-2 zijwayelekile.64 Abesilisa abasebasha bangadinga isikhathi esithe xaxa, mhlawumbe kuze kube izinyanga ezi-5, ngombono wokuthi ukusebenzisa kwabo izithombe zobulili ezingcolile kwe-Intanethi kuqale esemncane. Ukuvuka kwabantu ocansini kunesimo, ikakhulukazi ngesikhathi sokukhula nobusha, futhi kungaba namandla emadodeni kunakwabesifazane.65-67

ISILULEKO SOKUPHILA

Imisipha yaphansi ye-Pelvic edlala indima yokulungiswa kwama-erections buthaka nobudala. Ukwelashwa ngokomzimba ukuze kuqiniswe i-bulbocavernosus kanye nemisipha ye-ischiocavernosus nezicubu ezixhumayo kungalapha ngempumelelo i-ED kwezinye iziguli. Kokunye ukuhlola okwenziwe ngokungahleliwe, okulawulwayo, amadoda angama-40 ane-ED afundiswa ukukhipha ubukhulu bepenisi futhi baphakamise i-scrotum yabo kabili nsuku zonke lapho bemi, behleli, futhi belala phansi, futhi beqinisa imisipha yabo yaphansi yomphimbo ngemuva kokuchama. Imiphumela yamangaza - izinyanga eziyisithupha, ama-6% ababambiqhaza abuyiselwe umsebenzi ojwayelekile we-erectile kwathi abangama-40% bakhombisa ukuthuthuka okuthile; Ama-35% emadodeni nawo abike ukuthi kwehle ukwehla kokuchama ngemuva kokuchama. Indlela elula kungenzeka ukuthi ifundise iziguli zesilisa uKegel ukuzivocavoca ngokuthi ziyeke umchamo we-urine ukukhomba izicubu ezizodingeka ukwenza lo msebenzi. Le misipha kufanele ingenwe ngemizuzwana emi-66, amahlandla ayi-5 - 10 ilandelana, kathathu ngosuku. Abesilisa bangashukumiseleka ukwenza uKegel noma i-pelvic floor kuimarisha umzimba ngenxa yokuthuthuka kwekhwalithi ye-orgasm, umphumela ojwayelekile womphumela u-Arnold Kegel, MD ubhale amashumishumi eminyaka edlule kwabesifazane abenze uKegels njalo.68

I-VACUUM CONSTRICTION DEVICE

Idivaysi ye-vacuum constriction (VCD), ebizwa ngokuthi "iphampu yepipi" yenziwa nguGeddings Osbon ngonyaka we-1974.69 U-Osbon wayibiza ngokuthi "yithuluzi elilingana nentsha" futhi wathi wayisebenzisa uqobo iminyaka engama-20 ngaphandle kokwehluleka. Idivaysi yokuqala yobumbano be-vacuum yaba yi-FDA evunyelwe ku-ED ngonyaka we-1982.

I-VCD isebenza ngokukhuphula ukugeleza kwegazi okonweni ngokufaka umfutho ongemuhle we-110-225 mmHg (ngesandla noma ngepompo elisebenza ngebhethri) nangokuvimbela ukuphuma kwe-venous ngendandatho yensimbi. Ucwaningo luphakamisa ukuthi cishe amadoda angama-55-70% angazuza ama-erections afanele ngama-VCD.70, 71 Amanye amadoda abika ukuthi ukwakheka okutholakale kwi-VCD kuvame ukuhleleka, kubanda, noma kube nemiphumela emibi kufaka ukulimazeka komgodi wepile kanye nokubanjiswa kwe-ejaculate ngesikhathi se-orgasm eqenjini le-constriction. Indandatho yesifunda akufanele ishiywe isikhathi esingaphezu kwemizuzu engama-30 ngenxa yobungozi be-ischemia.

DIET, ISIVIVINYO, KANYE NOKULAHLEKA KULULA

Ukufuna ama-aphrodisiacs ukukhuthaza i-libido futhi kuthuthukiswe nezinsuku zokusebenza kocansi ezikhathini zakudala. Ngempela, igama elithi aphrodisiac livela kunkulunkulukazi wamaGrikhi wothando, u-Aphrodite, owazalwa olwandle futhi walethwa ogwini lwesibalo noma imbaza. Yize ama-oysters aqukethe amanani amaningi e-zinc adingekayo ukukhiqizwa kwe-testosterone, ukuyidla akuboniswanga ukwenza ngcono ikhono le-libido noma erectile.

Ukudla okuthile, noma kunjalo, kuthuthukisa impilo ye-vascular futhi, ngakho-ke, kungandisa ukusebenza kwe-erectile. Isibonelo, ukudla okuphezulu kuma-nitrate afana nama-beet kanye nama-greens amaqabunga kuphakamisa amazinga e-nitric oxide, kukhuthaze ukusebenza okujwayelekile kwe-endothelial, kanye nomfutho wegazi ophansi.72-74 Imbewu yepomegranate nejusi futhi kuthuthukisa ukusebenza kwe-endothelial kanye nomfutho wegazi ophansi ngenkathi kunciphisa i-LDL oxidized ne-glycated, ngaleyo ndlela kunciphise ukwakheka kwe-atherosranceotic plaque kanye nokuncipha kogqinsi lwodonga nokuqina.75-78 Isiphuzo esikhulu sombila we-fructose neziphuzo ezithambile kuphakamisa ingozi yokuba nesifo se-metabolic syndrome, isifo sokuqina kwemizwa, isifo sikashukela kanye ne-ED.79 Ngaphezu kwalokho, ukudla okunemikhiqizo yokugcina ephezulu ye-glycation efana ne-bacon, ama-hamburger okudla okusheshayo, izinja ezishisayo, ushizi, ipitsa nokudla okuthosiwe, kunomthelela kwisifo sikashukela, isifo senhliziyo, kanye ne-ED.80-82 Esikhundleni sokugxila ekugwemeni ukudla okuthile, kungazuzisa kakhulu kwiziguli ze-ED ukuthola ukudla kwaseMedithera ngamatha amaningi emifino, izithelo, uwoyela omnqumo owengeziwe, okusanhlamvu okuphelele, amantongomane, nezinhlanzi nokudla okulinganiselayo kwewayini. Ubufakazi obuvela kwizivivinyo ezine zemitholampilo zibonisa ukuthi ukudla kwaseMedithera kanye nendlela yokuphila enomthelela omuhle ekusebenzeni ngocansi,83,84 kanye nokwehlisa ukuvuvukala kanye nokubambezela ukungasebenzi kwezomzimba kwabesilisa abanesifo sikashukela.

Kunempikiswano encane yokuthi ukuvivinya umzimba kuthuthukisa izingozi ezimbalwa ezibangela i-ED kufaka phakathi ukunciphisa ukuvuvukala, ukuthuthukisa ukusebenza kwe-endothelial, ukukhuthaza ukuzwela kwe-insulin, ukuthuthukisa i-lipoproteins, kanye nokwenza ngcono ukulahleka kwamafutha kwe-visceral.85-89 Ukubuyekezwa okuhlelekile kwamuva nokuhlaziywa kwe-meta kuqinisekisa ukuthi ukuzivocavoca okulinganiselayo nokuqina ngamandla okungenani kwamasonto ayi-8 kungathuthukisa i-ED.90

Kokubili okunamafutha omzimba ngokweqile nangokwanele kuhlangene ne-ED. Isibonelo, iHallym Aging Study yakala amaphesenti omzimba wamafutha kanye nobudlelwano bawo ne-ED emadodeni aseKorea.91 Abesilisa abanamafutha omzimba aphansi futhi aphakeme kakhulu kungenzeka babe ne-ED. Ukukhuluphala okuphakathi kuhambisana ne-metabolic syndrome, ukungasebenzi komzimba, kanye ne-testosterone ephansi, konke okunomthelela ekuthuthukisweni kwe-ED.92,93 Izicubu ezinamafutha zibonisa ama-hormone nama-cytokines angaphezu kwama-35, cishe konke okuthuthukisa ukuvuvukala, ukumelana ne-insulin, futhi ekugcineni, isifo se-vascular.94,95 Ukuvuvukala kubonakala kungumdlali osemqoka odabeni lwe-ED. Abesilisa abakhubazekile abane-ED banamazinga aphezulu wezimpawu zokuvuvukala (i-IL-6, IL-9, IL-18, ne-CRP) nomsebenzi ophazamisekile we-endothelial kunamadoda aqatha ngaphandle kwe-ED.96

Ukwehla kwesisindo kungawuthuthukisa kakhulu umsebenzi we-erectile. Ku-RCT eyodwa, amadoda athambile alahlekelwe yisilinganiso samaphawundi angama-33 ngaphezulu kweminyaka emi-2 athuthukise ukusebenza kwezocansi.97 I-ED yathuthukisa ngaphezu kwe-30% yeqembu lokunciphisa isisindo ngokuqhathaniswa ne-5% yokulawula. Iqembu lokungenelela lithole ukwelulekwa okunempilo, ukweluleka ngokwenyusa ukusebenza komzimba cishe amahora amathathu ngeviki, kanye nemihlangano yanyanga zonke noma yamehlo. Ngaphandle kokunciphisa kwesisindo okuyisilinganiso esingu-3%, amadoda eqenjini lokungenelela abuye abonise ukwehliswa kwezimpawu zokuvuvukala i-IL-15 ne-hsCRP, ithuthukisa iphrofayili yengozi ye-cardiometabolic.

IBOTANICALS NE-AMINO ACIDS

Ukusetshenziswa kwama-botanicals, izakhi zomzimba, nezinye izindlela zokwelapha zemvelo zokuthuthukisa ukusebenza kocansi kukhule kakhulu ngenxa yokuthengisa kwe-Intanethi. Zimbalwa izindlela zokwelapha zemvelo eziye zabhekana nokuvivinywa kwabantu okuthola ukwelashwa ukuze kuxhaswe ukuphepha nokusebenza ngempumelelo. Kodwa-ke, ama-botanicals alandelayo nama-amino acid angasiza ekwelapheni i-ED, ikakhulukazi kwabesilisa abancamela ukungasebenzisi imishanguzo ye-PDE5i.

Pausinystalia yohimbe

UJohimbe ungowokuzalwa njalo enkabeni ye-Afrika equkethe ama-alkaloids amathathu: i-rauwolscine, i-corynanthine ne-yohimbine. Isimo esisebenza kakhulu se-yohimbe, yohimbine, umuthi onomshini ochazwe kahle wesenzo njengephikisi le-presynaptic α1 kanye ne-α2-adrenergic ne-5-HT (1B) ama-receptors kanye nama-agonist ayingxenye yama-5-HT (1A) ama-receptors.98 Ukuhlaziywa kwe-Meta kusikisela ukuthi i-yohimbine isebenza ku-ED99,100 I-Yohimbine nayo ingasiza ngekhono elibambezelekile noma ukungakwazi ukukhipha umzimba.101 Umthamo ngu-15-30 mg, kuze kufike ku-100 mg ngosuku. I-Yohimbe ingahle ihanjiswe ngokufunwa kakhulu kusukela ukuqala kushesha, kungakapheli imizuzu eyi-10 ukuya kwayi-15, nokuphila okuyimizuzu engama-35. I-Yohimbine ingena ohlelweni oluphambili lwezinzwa ngemiphumela emibi engahle ifaka phakathi i-tachycardia, umfutho wegazi ophakeme, ukuqubuka, nokukhathazeka. Ukuthukuthela, isicanucanu, isiyezi, ikhanda, nokushintshashintsha kwesikhumba nakho kuvamile. Njengawo wonke ama-botanicals, izinhlobo eziningi zokungezelwa kwe-the-counter kungenzeka zingathembeki. Ucwaningo olulodwa oluhlola izinhlobo ezingama-49 yohimbe zitholakale zinokuhlukahluka kwenani le-yohimbine - 0 kuye kwayi-12.1 mg - ngokukhonza kanye nezinhlamvu eziyi-19 ezingenawo ama-rauwolscine ne-corynanthine, eziphakamisa ukuthi zazivela ekuthwetshweni kwesitshalo okwenziwe kahle kakhulu noma okwenziwe ngemvelaphi.102

Tribulus terrestris

T. terrestris sikhula eYurophu, e-Asia, e-Afrika kanye nase-Middle East. Izimpande nezithelo zisetshenziswa isikhathi eside kuzo zombili umuthi waseChinese nase-Ayurvedic. Izimangalo zenziwa kaningi ukuthi i-Tribulus ithuthukise ukukhiqizwa kwe-testosterone; kodwa-ke, izivivinyo zomtholampilo azange zikuxhase lokhu kucatshangwa ngaphandle kokusebenzisa ngokungena emikhondweni yezimpawu.103-106 Izifundo zezilwane zikhombisile ukuthi i-Tribulus ingathuthukisa ukusebenza kwe-erectile kanye nokukhiqizwa kwe-NO.107,108 I-RCT eyodwa yamadoda ayi-180 ane-ED emnene ukuya ku-moderate esebenzisa i-500 mg yokulinganisa T. terrestris kuthathwe kathathu nsuku zonke kubikwe ukuthuthuka kwe-libido, i-ED, ukwaneliseka kokuya ocansini, nekhwalithi ye-orgasm. Ayikho imiphumela emibi eye yabikwa.109

I-Eurycoma longifolia

I-Eurycoma longifolia, eyaziwa ngokuthi iMalessian ginseng noma iTongkat Ali, isitshalo esinezimbali zomdabu e-Indonesia, iMalaysia, iThailand, iVietnam, iLaos neNdiya. Ukuhlaziywa kwe-meta-RCT kusikisela E. longifolia iphikisana kakhulu ne-ED.110 Ngaphezu kwalokho, ukubuyekezwa kwesiShayina kwezifundo ezishicilelwe kusikisela E. longifolia kuthuthukisa umthamo we-semen, libido, ne-testosterone.111 Isitshalo singaba nekhono le-adaptogenic, futhi sikhonjisiwe ukunciphisa ukwehla, ukuthuthukisa inhlala kahle, i-cortisol esezingeni eliphansi, kanye nokukhulisa i-testosterone ngezihloko ezicindezelwe.112 Ithathwe njengokukhishwa kwezimpande zamanzi, i-Eurycoma ibonakala iphephile ngaphandle kwemiphumela emibi ebalulekile. Umthamo ophakanyisiwe ngu-200-300 mg kanye noma kabili nsuku zonke, nefomu elinelungelo lobunikazi lifane nama-22% eurypeptides nama-40% glycosaponins.

I-Epimedium spp.

I-Epimedium spp. ukhule eChina naseKorea, futhi ungowomndeni wakwaBerberidaceae (obuye uqukethe i-botanicals eyaziwayo, I-Mahonia aquifolium, Hydparis canadensis, Futhi Berberis vulgaris). Okungenani izinhlobo ezingama-50 sekutholakele futhi zaziwa kakhulu ngokuthi “ukhula lwebhokhwe olubi kakhulu”. Isithako esisebenzayo, icariin, umuzwa we-flavonoid othuthukisa umsebenzi we-erectile ezifundweni zezilwane nge-PDE5 inhibition ne-nitric oxide induction.113-115 - Izilingo zomtholampilo zabantu zivuliwe I-Epimedium ziyashoda; Ngakho-ke, izincomo zemithamo azitholakali.

L-arginine

I-L-arginine iyi-amino acid, ebalulekile ezimweni ezinokuma kwe-arginase enzyme, njengesifo sikashukela nokuhluleka kwe-renal.116,117 I-Arginine isetshenziswa ama-enterocytes wamathumbu nama-hepatocytes futhi iguqulwa ibe yi-L-citrulline noma i-L-ornithine. Ukwehlukahlukana kokufakwa kwe-L-arginine yomlomo kuyacatshangelwa - umthamo we-6 g ucishe uzuzwe ngama-68% kanti umthamo we-10 g ungama-20% kuphela amuncwayo.118,119

I-Nitric oxide ingukukhiqizwa kokuguqulwa kwe-L-arginine ku-citrulline. Ngaphezu kwalokho, ukuxhaswa kwe-citrulline kukhulisa i-plasma arginine. I-Arginine ingathuthukisa i-ED kumithamo ephezulu; ngokwesibonelo, i-5000 mg ithuthukisa i-ED, ikakhulukazi uma ama-metabolites we-urine NO ephansi.120 Ngokucatshangelwa, i-L-arginine ingasebenza kangcono uma amazinga we-ADMA ephakanyisiwe. Njengoba i-ADMA ivimbela i-eNOS, i-enotme ye-endothelial edingekayo ekwenziweni kwe-NO, i-L-arginine supplementation ingasungula kabusha isilinganiso se-arginine-to-ADMA.121 I-L-arginine supplementation ingasebenza kakhulu ku-ED uma ihlanganiswa ne-yohimbine noma i-pycnogenol (i-pine bark ye Isikhombi sePinus).122-124 Ukungezelelwa nge-L-arginine kungasebenza kusebenze i-herpes futhi kwandise ukuqubuka. Ngaphezu kwalokho, i-RCT eyakhishwa ngonyaka ka-2013 yabika ama-3000 mg we-L-arginine othathwe izikhathi ezi-3 ngosuku anda ingozi yokushona kweziguli ezine-MI yakamuva.125

IMIPHAKATHI YEMPILO YAMAHHALA

Izindlela eziphambili ze-pharmacological ze-ED zingama-PDE5 inhibitors, apomorphine, kanye ne-intracavernosal injection Therapies.

Ama-PDE5 inhibitors

I-Phosphodiesterase hlobo 5 inhibitors (PDE5i) yiyona ndlela ejwayelekile yokwelapha izidakamizwa ye-ED. Imishini yabo yokusebenza yaziwa kahle, ivimbela uhlobo lwe-phosphodiesterase 5 enisa i-cGMP, yandise ngempumelelo umsebenzi we-NO kumithambo ye-penile. Imithi kuleli klasi ihlukile ekukhetheni kwayo kwama-isoenzymes ayi-11 ahlukile. Lokhu kuhlangana kabusha nge-PDE isoenzymes kutholakala ikakhulukazi kumasipha, i-visceral, kanye ne-pulmonary laini yemisipha futhi kunomthelela emiphumeleni emibi.126 Isibonelo, i-vardenafil ne-sildenafil kungenzeka kathathu ukubopha ku-PDE6, i-enzyme ku-retina edlulisela ukukhanya ku-nerve impulses. Ukuvinjwa kwale enzyme kubangela ukuphazamiseka kokuqonda kombala okwaziwa ngokuthi yi- "chromatopsia."

Izidakamizwa ezine ze-PDE5i zivunyelwe i-FDA - i-sildenafil ngonyaka we-1998, i-vardenafil ne-tadalafil ngo-2003, kanye ne-avanafil ngonyaka ka-2012. Akukho zilingo zokukhanda ukuqhathanisa ukusebenza kahle kwale mishanguzo. Le mishangu yehluka ekuqaleni, ubude besikhathi sokusebenza, kanye nemiphumela emibi.127 Ukuqala kwe-sildenafil ne-vardenafil kuyinto imizuzu engama-30-60 enesikhathi samahora angama-10 kuya kwayi-12. Ukuqala kukaTadalafil yimizuzu eyi-15 kuya kwengama-30 kuye ngesilinganiso, isikhathi eside kakhulu samahora angama-36. I-Avanafil ineziqalo ezimfushane kakhulu, kungakapheli imizuzu eyi-15 nobude, cishe amahora ayi-6.

Ukusetshenziswa kwe-PDE5i kunganciphisa ingozi yomdlavuza wendlala yesibeletho, mhlawumbe ngoba abesilisa abayisebenzisayo bangahlehla kaningi, okuvikela umdlavuza wendlala yesinye.128,129 Isikhati eside sildenafil Ukusetshenziswa kwe-citrate (Viagra) kuhlotshaniswa nengozi ekhulayo kancane ye-melanoma.130 Imiphumela emibi ejwayelekile ye-PDE5i ifaka ikhanda kumadoda aze afike kuma-20%, eshayisana aze afike ku-15%, kanye ne-dyspepsia kanye nokucinana kwamakhala kufinyelela ku-10%. Yize kungajwayelekile, isiyezi nokuqagela kungenzeka. Onke ama-PDE5i ancintisanayo kumadoda athathe ama-nitrate.

I-Apomorphine

I-Apomorphine ibilokhu isetshenziswa kusukela ngo-1869 ngesifo sikaParkinson, futhi yafundelwa umphumela wayo ekusebenzeni kwe-erectile. Yize isuselwa ku-morphine, i-apomorphine ayiqukethe i-morphine noma ibophele kuma-opioid receptors. Inokuhlangana okuphezulu kwama-dopamine receptors kanye nendlela yokwenza ngcono i-sex drive kanye nama-erections kungenzeka ngokuhambisana okulinganiselayo kwama-D2 receptors ohlelweni lwe-hypothalamus kanye ne-limbic system.131 Esigabeni sabantu II nesivivinyo somtholampilo wesigaba sobuntu esibandakanya amadoda angama-5000, ama-3 mg mg we-apomorphine engalingani akhiqize ama-erections aqine ngokwanele ukungena ngaphakathi kwemizuzu eyi-4-10, ngokuthuthuka cishe kuka-25-20% ngaphezulu kwe-placebo.132,133 I-apomorphine yezemithi enelungelo lobunikazi e-US kuphela ejova i-Apokyn, evunyelwe i-FDA yokuqhubekisela phambili isifo sikaParkinson; noma kunjalo, i-apomorphine ingahlanganiswa njenge-lozenge engalingani futhi ingahlanganiswa ne-PDE5i. Imithamo ye-2-3 mg ingahle isebenze njengaleyo ye-4-6 mg ngaphandle kwemiphumela emibi njengokucanuzelelwa inhliziyo, ikhanda, noma isiyezi. I-Apomorphine akufanele isetshenziswe ngokubambisana ne-ondansetron hydrochloride, i-antiemetic ejwayelekile evunyelwe, ngenxa ye-hypotension engaba khona.

Imijovo ye-Intracavernosal

Kwethulwe ngonyaka we-1983, imijovo ye-intracavernosal moderate endothelial function futhi isebenza kahle kakhulu emadodeni ane-ED ezinzima; i-alprostadil ikhiqiza ama-erections afinyelela kuma-93% amadoda, ngempumelelo ye-bi-, tri-, kanye ne-quad -xube efinyelela ku-97.6%.134-136 I-Alprostadil, engu-20 noma engama-40 ofg ye-prostaglandin E1, ukuphela komjovo we-intracavernosal ovunyelwe we-FDA, kanti eminye eminye imithi emibili, i-phentolamine ne-papaverine, ingafakwa ku-PGE1 kwifomula ehlanganisiwe. Umphumela wecala ovame kakhulu we-PGE1 kuphela ubuhlungu ku-48.5% wamadoda. I-Bi-mix, evame ukuqukethe i-0.5-3.0 mg ye-phentolamine ne-30 mg papaverine, ayibangeli buhlungu kepha ingahle ingasebenzi. I-Tri-mix, imvamisa equkethe ama-5- μg (g (aze abe ngu-10 μg) we-PGE40, 1-0.5 mg phentolamine, ne-1.0-15 mg papaverine, anciphisa amathuba obuhlungu abe ngu-30%. Ukufakwa kwe-2.9 mg ye-atropine ku-quad-mix, ebekelwe amadoda okuthi ukuxutshwa okungunxantathu kungasebenzi, kubuhlungu kakhulu obubuhlungu. Inani le-PGE0.15, bi-, tri-, noma i-quad-mix edingekayo lihlukahluka ukusuka ku-1 kuya ku-0.1 mL. I-Empiric (isebenzisa i-PGE0.3 kuphela kungakhathalekile nge-etiology ye-ED noma ubulukhuni, ngemithamo noma ngokulungiswa kwefomula eyenziwe ngemiphumela yesiguli) nokususelwa ebungozini (kusetshenziswa i-bi-mix, i-tri-mix, noma i-high-dose-mix esekelwe ku-algorithm factoring ED I-etiology kanye nenombolo yezici zobungozi ze-ED) izindlela eziya ku-dosing zibonakala zifana ngokusebenza kahle kanye nezinkinga zokuqina nokweneliseka.137 Imiphumela emibi ifaka phakathi izinhlungu endaweni yomjovo, i-priapism, kanye nokukhula kwezicubu zesilonda noma isifo sikaPyronie. Ukuze uthole i-athikili enhle ebukeza ukusebenza kahle, imithamo, nemiphumela emibi yemijovo ye-intracavernosal, bheka isifinyezo se-Medscape esithi "Intracavernosal Injection Algorithm" nguJeffrey Albaugh.138

ISIVIVINYO SOKUPHUMA KOKUKHANYA KWEZOBUCHWEPHESHE

I-low intensity extracorporeal shockwave (LI-ESW) yaqalwa ngonyaka wama-1990s lapho kukhonjiswa i-ultrasound ukuze ifake i-angiogeneis emanxebeni e-rat.139 I-LI-ESW isebenzisa amaza okushaqeka, uhlobo lwamandla egagasi elinamandla futhi lenze ukusabela kwemvelo lapho kusetshenziselwe ukubhekisa izicubu.140 Inqubo iyahlukahluka ngokuya ngamandla we-fluxx frequency, imvamisa (inani lamamaphini ngomzuzwana ngamunye ku-Hz), kanye nenani eliphelele lemipu elethwa. Ukusebenza kwesenzo sokwenza ngcono kwe-ED kubukeka sengathi kuvuselelwa kabusha kwe-penile neuronal nitric oxide (nNOS) izinzwa ezakhayo, ukukhishwa okuthuthukile kwe-nitric, kanye ne-endothelial kanye ne-vascular bushelelezi yemisipha yokulungisa amaseli ngokuqasha amaseli we-mesenchymal stem cell.141 Ukwelapha kungabuye kusebenze amaseli we-penile progenitor endawo.142 Njengamanje, i-LI-ESW ayivunyelwe i-FDA ku-ED; kodwa-ke, izivivinyo eziningi zemitholampilo zenziwe ngephrofayili yokuphepha enhle nophumelelayo ehlukahlukene.

Ucwaningo lokuqala lokushayela umshayeli we-ED olushicilelwe ngonyaka we-2010 lusebenzise izikhathi eziyisithupha ze-LI-ESW emadodeni angama-20 ayengaphenduli ama-PDE5 inhibitors (PDE5i). Imiphumela ikhombise ukusebenza okuthuthukile kwe-erectile, ubude bama-erections, nokuqina kwe-penile ngenyanga eyi-1. Ukuthuthuka kwabikwa ukuthi kuze kube izinyanga eziyisithupha zokulandela.143 Ama-RCT amaningana abike imiphumela emihle esebenzisa i-LI-ESW. Kwisivivinyo esisodwa esihilela amadoda angama-67 ane-ED aphendule kwi-PDE5i, ingalo yokwelashwa yathola amaseshini ayi-12 ngokusebenza okuthuthukile kwe-erectile kanye ne-penile hemodynamics ebonwe cishe ema-50% amadoda ngaphandle kokusebenzisa i-PDE5i yawo.144 Kwi-RCT efanayo e-India kufaka phakathi izimpendulo ezingama-135 zePDE5i eziphathwe ngamaseshini ayi-12, ama-78% amadoda aphathisiwe akwazi ukuthola ama-erections aqine ngokwanele ukungena ngaphandle kwemithi ngenyanga eyi-1.145 Yize le miphumela ibasekelwa lapho kulandelwa unyaka owodwa, bekunezinga eliphakeme kakhulu lokuyeka emsebenzini kufaka phakathi i-1% yabamampunge nama-58% wezingalo zokwelashwa.

Amadoda angaphenduli i-PDE5i angaba abaphenduli ngemuva kokwelashwa kwe-LI-ESW. Kwilebula evulekile, ucwaningo olulodwa lwengalo yamadoda angama-29 olungaphenduli ku-PDE5i, ukwelashwa okungu-12 kuholele ekutheni amadoda angama-72% akwazi ukufeza ama-erections aqine ngokwanele ukungena nge-PDE5i.146 Kwi-RCT yakamuva kufaka phakathi i-58 PDE5i abangaphenduli, ama-54% aphendule ku-PDE5i ngemuva kwenyanga eyi-1 ye-LI-ESW yokwelapha kuqhathaniswa ne-0% eqenjini le-sham.147

Ukuthuthuka okuqhubekayo okubonwe ocwaningweni olude lokulandelela kubonisa ukuthi kulandela ukwelashwa, amanye amadoda angahle ayiguqule i-pathology eyisisekelo ebangela i-ED yawo noma ukuthi i-LI-ESW inganikeza isilinganiso esithile sokuvuselelwa kwengqondo. Ku-RCT eyodwa yokulandelwa kwezinyanga eziyi-6 zamadoda ayi-112, wonke athola izikhathi ezinhlanu zokwelashwa selokhu ingalo ye-placebo ithole ukwelashwa okusebenzayo emavikini ayi-10, ezinyangeni eziyi-6, cishe ama-20% engalo yokwelashwa yokuqala nama-23% okuqala okwelashwa I-placebo group besakwazi ukulala ngaphandle kwemithi.148 Okunye ukulandela unyaka 1 kwamadoda amadala angama-50 (isilinganiso seminyaka engama-65 ubudala) ezinobungozi bemisipha kufaka phakathi isifo sikashukela, umfutho wegazi ophakeme, i-dyslipidemia, kanye nesifo se-coronary artery sifo sathola ukuthuthuka okuqinile kwe-ED ubukhulu kanye nekhwalithi yokuzakhela yokubika.149

Isibalo sokwelashwa kwe-LI-ESW ngemiphumela efanele nokuthi isikhathi eside kangakanani sisebenza asaziwa. I-RCT yakamuva yenziwa ngamadoda ayi-126 esibhedlela saseDenmark eqhathanisa nabesilisa abathole izikhathi ezinhlanu uma kuqhathaniswa nezikhathi eziyishumi ezinyangeni eziyisithupha nezingu-6; Ukwelashwa bekucishe kube ngama-12% kusebenza kuwo womabili amaqembu, kuphakamisa ukuthi izikhathi ezengeziwe zingahle zingathuthukisi umphumela.150,151 Ekulandelweni kweminyaka emibili kwelebuli evulekile enamadoda ayi-2, ama-156% athuthuke emavikini ama-63 ngokusebenza kahle kwe-4% iminyaka emi-53.152 Akumangazi ukuthi amadoda ane-ED ezinzima abe nokuhluleka kwangaphambilini. Zonke iziguli ezinesifo sikashukela kanye ne-ED ezinzima zilahlekelwe ngomphumela, kanti ama-76% amadoda ane-ED emnene futhi ngaphandle kwesifo sikashukela agcinile ukusebenza kahle.

Isibalo sezifundo ezisebenzisa i-LI-ESWT ye-ED sikhuphuke kakhulu eminyakeni yamuva. Ukubuyekezwa okulandisayo kwezincwadi ezishicilelwe ezenziwa ngonyaka we-2013 kubike ukuthi ama-60-75% abaphenduli bePDE5i angathola ukufinyeleleka ngokwanele ekungeneni ngaphandle kwemithi kanti ama-72% abantu abangaphendulanga be-PDE5i baba ngabaphenduli.153 Ukuhlolwa kwe-meta kwakamuva nje kuhlaziya izifundo eziyi-14 kufaka phakathi ama-7 RCTs kutholile ukuthi ukwelashwa kwe-LI-ESW kuphephile futhi kuyasebenza, kube nemiphumela ehlala izinyanga ezi-3 okungenani.154 Amadoda ane-ED emnene noma elinganiselayo abonakala ephendula kangcono kunamadoda ane-ED ebucayi, ene-flux density, inani lamagagasi athukile, kanye nesikhathi sokwelashwa esihambisana kakhulu nomphumela.

I-PRP NO-STEM CELL INJECTION

Ukufakwa kwamaseli wezinhlayiya ze-plasma (PRP) noma ama-mesenchymal stem ku-corpus cavernosum unesithembiso sokuthuthukisa i-ED nokubuyisela umsebenzi we-penile artery kanye nerve. Ukulungiselela i-PRP, ama-platelet aqhamuka egazini elwa ne-anti-ehlanganiswe nge-spun ku-centrifuge futhi agxilisiwe. I-PRP iqukethe amaprotheni angaphezu kwama-300 e-bioactive, izici zokukhula, nama-molecule wokunamathela angathuthukisa ukwelashwa kwezicubu futhi akhuthaze ukuvuselelwa kwezicubu ze-nerve kanye ne-vascular.155-157 Njengoba i-penile vasculature iyindawo ecebile kakhulu yomzimba womuntu nokugeleza kwegazi ku-penaccid penis kuhamba kancane uma kuqhathaniswa nokujikeleza kwe-systemic (ukuvumela ukugcinwa okungcono), theoretically, PRP kunganikeza izinzuzo kwezicubu ze-penile ezifana nokuthuthuka okubonwe ekulimaleni kwamathambo .

Zimbalwa izivivinyo zokuphepha nokwenzakala okwenziwa nge-PRP ze-ED ezishicilelwe. Isivivinyo esisodwa sabantu esenziwa e-Italy sihlole abesilisa abayi-9 abane-ED abathole i-PRP ngaphezu kwezokwelapha utupu. Ukuphuculwa kobumnene kubonakale ngomphumela omncane ongemuhle wobuhlungu obumnene nokulimala endaweni yomjovo.158

Amazinga ancishisiwe amangqamuzana e-endothelial progenitor ajikelezayo, uhlobo lweseli leseli elidingekayo ekuvuseleleni i-vascular endothelial lining, liyisici esizimele sobungozi ku-ED.159 Ama-EPC ancishiswa ngokuvuvukala okungapheli okubonwa kushukela, i-hypercholesterolemia, ukukhuluphala, isifo senhliziyo nokubhema ugwayi.160 Izifundo zezilwane ziphakamisa ukuthi i-testosterone ikhuthaza ukuhlanganiswa kwe-EPC kusuka kumnkantsha futhi ithuthukise i-angiogeneis.161,162 Ukubuyekezwa okubili kwezifundo zezilwane ezishicilelwe ezibandakanya imijovo ye-intracavernosal yamaseli we-stem ethathwe kumongo wethambo, izicubu ze-adipose, kanye nomsipha wamathambo kubike imiphumela emihle ekunciphiseni kwe-endothelial, izicubu ezibushelelezi, nomsebenzi wezinzwa kwezicubu ze-penile.163,164

I-PRP kanye ne-stem cell therapy ingasiza abesilisa abalimele i-vascular and nerve kusuka kukashukela noma i-radical prostatectomy. Izifundo ezimbalwa zomshayeli womuntu ziphakamisa ukuthi inqubo ingahle iphephe futhi isebenze. Olunye ucwaningo lufake phakathi kwabesilisa abayi-11 abathola i-Prostatectomy eyi-radical ngenxa yomdlavuza wendlala yesinye, kwaba nemiphumela yokungaphenduli kwe-PDE5i.165 Amaseli we-stem cell we-Autologous adipose afakwe ku-corpus cavernosum athola umsebenzi we-erectile emadodaneni ayisishiyagalombili nanye ngaphandle kwemiphumela emibi. Kokunye isifundo somshayeli osebenzisa amaseli we-non-autologous human umbilical stem cell, amadoda amadala ayisithupha kwabayisikhombisa anesifo sikashukela kanye ne-ED engaphenduli ku-PDE5i, athola ukwakhiwa kwasekuseni ngenyanga yesithathu, kwathi amabili kwabayisikhombisa abesakwazi ukufeza ubumbano nge-PDE5i ngemuva kwezinyanga eziyi-6. Ngokuthakazelisayo, i-glucose yegazi yehle emavikini ama-2 ngemuva kokujova, ngamazinga we-hemoglobin A1C athuthukisiwe izinyanga ezi-4, futhi akukho miphumela emibi eyabonakala. Imiphumela emihle yabuye yabonwa ocwaningweni lomshayeli womuntu ohlanganisa amadoda ayi-12 ane-post-radical prostatectomy ED engasabeli kakhulu ku-alprostadil, PDE5i, noma kudivayisi ye-vacuum.166 Lesi sigaba I sivivinyo sisebenzisa imithamo ekhulayo yamangqamuzana esiqu esivela emthanjeni. Imithamo ephakeme ibisebenza kakhulu ngamadoda ayisishiyagalolunye kwabayishumi nambili okwazile ukufeza ama-erections aqine ngokwanele ukungena nge-PDE5i; izinzuzo zatholwa ngonyaka owodwa ngaphandle kwemiphumela emibi.

Ngenkathi imijovo yeseli ye-PRP ne-stem ibhekwa njengeyilingo futhi ingekho imvume yokugunyazwa yi-FDA kanye nomshuwalense, amadoda angafuna abasebenza owenza lezi zinqubo. Imiphumela emibi engaba khona ifaka phakathi ukutheleleka nokukhula kwezicubu zesilonda noma isifo sikaPyronie. Ngokwe-theoretically, ama-stem cell nawo angakhuphula i-tumorigeneis, noma ngabe ubukhulu balengozi abaziwa.167

ISIPHETHO

Ukungasebenzi kahle kwe-Erectile kuyinkinga ejwayelekile yezokwelapha enezinto eziningana ezingenzeka, ezivame kakhulu ukufaka izimbangela nezimbangela. Ukuthatha umlando ngokucophelela nangokucophelela, ukusetshenziswa kwamaphepha emibuzo aqinisekisiwe, ukuhlolwa ngokomzimba, nokusebenza kwelebhu kuyadingeka ukuthuthukisa uhlelo lokukhulisa izimpawu ngenkathi kukhulunywa ngezimbangela eziyimbangela. Izinketho zokwelashwa zibandakanya ukuguqulwa kokudla nendlela yokuphila, ukuzivocavoca umzimba, ukusetshenziswa kwamadivaysi e-vacuum constriction, izithako zokudla ezidliwayo ze-botanical kanye ne-amino acid, imithi yokwelapha, ukuqina okuphansi kwe-extracorporeal shockwave therapy, futhi okungenzeka ukuthi i-plasma ecebile ye-plasma noma i-stem cell intracavernosal

IZINHLOBO ZOKUZIPHATHA KAKHULU
  • Yenza umlando omuhle, imibhalo yemibuzo, ukuhlolwa, umsebenzi ofanele welebhu
  • Xoxa ngezimbangela / neqhaza:
    • I-Psychogenic
    • kwemizwa
    • Ukusetshenziswa ngokweqile kwezithombe zocansi
    • endocrine
    • Imiphumela emibi yemithi
    • Izinguquko zeseli
  • Buyekeza izinketho zokwelashwa ezifanele:
    • Ukwelulekwa ngokwezengqondo
    • Ukuziba Izithombe zocansi
    • Ukwelashwa ngokomzimba (Kegel's) noma ukusetshenziswa kocingo lwe-vacuum constriction
    • Izinguquko zokudla
    • Ukuncoma ukuzivocavoca
    • Izinketho zokunciphisa isisindo
    • Amakhambi amakhambi kanye nama-amino acid
    • Imithi:
      • PDE5i: ukuqala okuhlukile, ubude besikhathi sokusebenza, kanye nemiphumela emibi
        • Kwangathi noma kungaze kumbozwe ngumshuwalense, kungabiza
        • I-Apomorphine, hhayi evunyelwe i-FDA ye-ED, kufanele ihlanganiswe
    • I-low-intensity extracorporeal shockwave
    • Ayigunyaziswanga i-FDA ku-ED kanye nokuntuleka kokubanjiswa komshuwalense
    • Imininingwane yezokuphepha yinhle ngezifundo eziningi zibonisa imiphumela emihle
    • Kungadinga ukwelashwa okuphindaphindiwe
  • I-PRP kanye nokulimala kweseli
    • Akunconyiwe ngenxa yokuntuleka kokuhlolwa okungahleliwe nokukhathazeka okuphepha
UKUFUNDA IZINHLAZO

Umbhali uthi akanazo izintshisekelo zokuncintisana.

IMISEBENZI KANYE NEMALI

Akunamali etholakele yokulungiselela nokubhala le ndatshana.

IZINDAWO ZOLWAZI
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I-DOI: https://doi.org/10.14200/jrm.2019.0104

Qaphela: idatha esethi ngaphansi kwenombolo yengcaphuno 6 ithi https://bedbible.com/sex-frequency-statistics/.