الفهرس 
ANATOMY OF THE PENISOnly 14 pages are availabe for public view
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Abstract
S
exual dysfunction is a set of disorders characterized by physical and psychological changes that result in the inability to perform satisfactory sexual activities. The condition has been found to be significantly more common in men and women with chronic kidney disease (CKD) than in the general population. Men with CKD frequently suffer from reduced libido, erectile dysfunction and difficulty reaching orgasm. Approximately 50% of male predialysis CKD patients and 80% of male dialysis patients have erectile dysfunction.
Penile erection during sexual stimulation is caused by increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic guanosine monophosphate (more commonly known as cyclic GMP or cGMP) in smooth muscle cells. cGMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.
Our study about the safety and efficacy of different modalities of treatment of erectile dysfunction in CKD patients using sildenafil, vardenafil, tadalafil and alprostadil.
Our study included 15 patient in every group:
The 1st group showed increase in the overall IIEF to 11 of the patients and improvement in the erection hardness scale too and 4 patients showed no improvement no complaint for the treatment recorded just mild side effects like flushing and headache.
The 2nd group showed increase in the overall IIEF to 10 of the patients and improvement in the erection hardness scale too and 5 patients showed no improvement and no complaint recorded too just mild side effects like flushing and headache with lower incidence than sildenafil.
The 3rd group showed increase in the overall IIEF to 12 of the patients and improvement in the erection hardness scale too and 3 patients showed no improvement and no complaint recorded too just mild side effects like headache, myalgia and nausea which was mild and not annoying the patient.
The 4th group showed increase in the overall IIEF to 13 of the patients and good improvement in the erection hardness scale too and 2 patients showed no improvement but 5 patients complained of minor cut. Hematoma 0.5 mm resolved spontaneously at site of injection and mild penile pain.
The demographic data used in our study was age of the patient, Haemodialysis years, S.Cr and DM. the study showed negative correlation between these issues (age, HD years, S.Cr and DM) and the erectile function as shown in their scores in IIEF and EHS.
Sildenafil showed total improvement in erectile function with sildenafil according to IIEF score and EHS, The mean score pre administration of sildenafil in IIEF was 8.73 and the mean score post administration of sildenafil was 14.6 and the mean score in EHS pre administration of the drug was 1.27 and the mean score post administration of sildenafil was 2.4 so there was highly significant increasing in IIEF and EHS pre and post administration of sildenafil with p value <0.001. it is safe too and the side effects showed flushing and headache only and was mild not annoying the patient. 86% of the patients complained of side effects which was flushing (69%) and headache (30%).
Sildenafil and Vardenafil showed no statistical significant difference in their effect on erectile function but sildenafil had mild higher effect in IIEF score and EHS. Vardenafil showed efficacy and safety. The mean score pre administration of Vardenafil in IIEF was 8.53 and the mean score post administration of Vardenafil was 14.07 and the mean score in EHS pre administration of the drug was 1.27 and the mean score post administration of Vardenafil was 2.4 so there was highly significant increasing in IIEF and EHS pre and post administration of Vardenafil with p value <0.001. Vardenafil showed less incidence of side effects than sildenafil only 53% of patients complained of side effects.
Tadalafil showed overall improvement in erectile function in haemodialysis patients with safety of the drug on them no recorded severe side effects, the observed side effects was headache, myalgia and flushing that was mild with dose of daily 5 mg and 20 mg at day of intercourse. The mean score pre administration of Tadalafil in IIEF was 8.27 and the mean score post administration of Tadalafil was 14.6 and the mean score in EHS pre administration of the drug was 1.4 and the mean score post administration of Tadalafil was 2.6 so there was highly significant increasing in IIEF and EHS pre and post administration of Tadalafil with p value <0.001. The side effects recorded in 66% of patients which was flushing in 10%, headache in 60%, nausea in 10% and myalgia in 20%.
Intracavernosal injection of alprostadil showed the best improvement in erectile function in IIEF score an EHS score among the used drugs in our study and safety with side effects of local haematoma that was mild and cured spontaneously and showed also mild penile pain, no priapism observed in any patient in our study. The mean score pre intracavernosal injection of alprostadil in IIEF was 7 and the mean score post intracavernosal injection of alprostadil was 16.93 and the mean score in EHS pre intracavernosal injection of alprostadil was 0.9 and the mean score post intracavernosal injection of alprostadil was 3.07 so there was highly significant increasing in IIEF and EHS pre and post intracavernosal injection of alprostadil with p value <0.001. The side effects recorded in 53% of patients which was local hematoma at site of injection in 50% of the patients which subsided spontaneously and headache in 12 % of the patients and penile pain in 37% of the patients.
Our study showed lower score of IIEF and EHS scores in diabetic patients pre and post administration of the treatment used in the study and also showed that there is negative correlation too between S.Cr and patients erectile function.