الفهرس 
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Abstract
The aim of our study was to evaluate the value of adding L- Arginine to Sildenafil and study its effect on improving erectile function, patient tolerability and quality of life.
Our study included 60 patients with erectile dysfunction divided into two groups: group 1 received sildenafil only and group 2 received sildenafil and arginine.
The mean age of our study groups was 55.4±9.1 years for the group received sildenafil only, and 55.6±8.1 years for the group received sildenafil and arginine; with non significant difference between the two groups. This was similar to the mean age of Neuzillet et al., (2013) where the mean age 56.46±9.26 years.
Nearly two thirds of our cases had manual occupation, either workers or farmers, and this was similar between the two groups, with non significant difference. 60% of our cases came from rural areas, which is similar also in the two groups. All of our patients were married with usual marital life. The mean number of children was slightly higher among group 1 cases (2.2) compared with group 2 (1.9), but with non significant difference. Only 10% of group 1 and 17% of group 2 had no children at all. 80% of group 1 cases and 67% of group 2 cases were smokers, with non significant difference between the two group. the majority of smokers were cigarette smokers.
More than 86% of our cases had ED with gradual onset and progressive course, and this was similar in the two groups, with non significant difference. The duration of ED was slightly longer in group 2 cases (7.93±3.66 months) compared to group 1 (7.47±5.16); however, the difference was not significant. Around 70% of our cases had normal intercourse within the last 3 months, and from them about 30-40% had normal intercourse within the last month. This was similar in the two groups. More than 70% of our cases had nocturnal erection, with a mean of around 3±1.5 per night. This was also similar in the two groups, with non significant differences.
The co-morbid diseases of our study were hypertension, DM, IHD or neuropsychiatric conditions. The most common chronic disease was hypertension, seen in 13% of our cases in both groups. This was followed by DM and IHD, present in less than 10% of cases. Neurological system affection was seen in only two cases (one in each group) and psychiatric manifestations were manifest in only one patients from group 1. For all of these diases, the prevalence in both groups was somewhat similar, with non significant differences.
Past history of trauma was positive in 10% of cases in both groups. Past history of similar conditions was present in 3 cases (2 in group 1 and 1 in group 2). No past history of vascular surgery, stroke or myocardial infarction.
Although group 2 cases showed more improvement than group 1, there is non significant difference between the two groups in the penile doppler picture either before or after treatment.
The mean international index of erection function (IIEF) score (erectile function section) was 20.63±2.82 in group 1 cases compared to 20.93±2.39 in group 2 cases; the difference here was non significant. The score increased in both groups after treatment to reach a mean of 22.77±2.7 in group 1 cases and 23.73±2.97 in group 2 cases. The improvement was more among group 2 cases, with a significant difference compared to the improvement of group 1.
Comparing the international erectile score index of both groups before and after treatment using paired t test statistic showed highly significant improvement in the two groups.
The complications associated with treatment were mild and reversible in most of cases, with slightly higher incidence of complications in group 2 patients compared to group 1 patients, which was only significant in nausea at the 4th week, which was seen in 5 patients in group 2 and non in group 1.
Smoking had negative effect but not significant on the erection score before treatment. After treatment, the improvement was much higher among non smokers compared to somkers, with a significant difference in both groups.
Conclusion
Arginine can be used as an additive treatment to sildenafil for the treatment of erectile dysfunction, with a good safety and acceptable efficacy.