الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 135 |  |  |
| | | from | 135 | | |
Abstract
Erectile dysfunction (ED) is defined as the consistent inability to attain and/or maintain penile erection with sufficient axial rigidity for satisfactory sexual intercourse.The pathophysiology of ED may be psychogenic and/or organic including vasculogenic, neurogenic, anatomical, hormonal and drug-induced. The etiology of ED is multifactorial and shares common risk factors with cardiovascular disease, such as obesity, diabetes mellitus, metabolic syndrome and smoking. However, the main cause is degenerative changes from endothelial dysfunction.There are four classic risk factors for both CVS and ED, and are all influenced by 25(OH)D, namely; arterial calcifications, endothelial dysfunction, hypertension, and diabetes. The aim of the present work was to evaluate serum level of vitamin D in patients with erectile dysfunction receiving sildenafil therapy. The possibility of usage of serum level of vitamin D as a predictor for response to sildenafil therapy was also evaluated.This study was carried out over 55 cases with erectile dysfunction (patients group) versus 30 age matched healthy potent individuals (control group). The cases group involved male patients between 20-60 years of age, married, in stable relationship, complaining from erectile dysfunction for more than 6 months duration.All the cases were subjected to; full medical& Sexual history, assessment of erectile function by International Index of Erectile Function (IIEF5) score before and after sildenafil administration, thorough Physical & Genital examination including genital reflexes, biochemical blood tests (fasting and postprandial blood glucose levels, serum level of cholesterol and triglycerides), Biosthesiometer, hormonal analysis (serum levels of total testosterone, and prolactin). In addition, specific investigations included serum level of 25 hydroxy vitamin D (25(OH)D) and pharmacopenile duplex ultrasound (PPDU) after intracavernosal injection of 10 µg prostaglandin E1 to estimate end diastolic velocity, peak systolic velocity and resistance index in the patients of the study group.Moreover, sildenafil (Viagra) was administrated by the patients starting by 50 mg, one hour before intercourse on an empty stomach. If insufficient response was obtained, the dose was escalated to 100 mg. If no response to sildenafil, after four consecutive doses of 100 mg, the patient was defined as non- responder based on Global Assessment Question (GAQ) – double checked against results of IIEF score “with failure”On the other hand, the control group was subjected to biochemical, hormonal and serum 25(OH) Vitamin D level investigations.Lastly, 25(OH) D serum level was compared between the patients and control groups. Also, sildenafil responders and non-responders subgroups were compared with each other regarding 25(OH) D serum level and IIEF score.Results of this study showed; no significant differences between the patients group with erectile dysfunction and the control group regarding; the age and testosterone and prolactin hormonal assays. However, there were higher serum level of both cholesterol and triglycerides and blood glucose level in the patients group in comparison to the control one. In the patients group, the serum level of vitamin D was significantly high versus that in the control group.In addition, in the study group, IIEF5 assessment showed significant decrease of the degree of ED, from “the moderate degree” before sildenafil intake to the “mild degree”, after sildenafil treatment.Moreover, from 55 patients, 67% (37 cases) responded to sildenafil treatment (responders) while, 33% of the patients (18 cases) exhibited no response (non- responders). There were no significant differences between responder and non-responder sub-groups regarding the age and testosterone and prolactin hormonal assays.However, compared with the responder sub-group, there was significantly high serum level of triglycerides in the non-responder sub-group. On the other hand, there was insignificant difference in serum level of cholesterol between both subgroups. Also, no significant differences regarding fasting and post-prandial blood glucose between the responders and non-responders, however, both parameters were more than the normal level.On the other hand, the serum level of 25(OH)D in responders was “insufficient” versus “deficient level” in the non-responders, with significant difference between both groups.However, the differences in the end diastolic velocity, peak systolic velocity and resistance index, of the pharmacopenile duplex ultrasound investigation, were statistically non- significant between both of the responders and the non-responders subgroups.In both the responder and the non-responder subgroups, IIEF5 assessment exhibited high significant changes post-treatment with sildenafil versus pre-treatment. However, in the responder cases, the degree of ED showed changes from moderate to mild, while in the non- responder cases, the change remains within the moderate degree. The study also revealed that IIEF5 score change was correlated positively with vitamin D and triglycerides serum levels and also with resistance index. However, the linear regression model was statistically significant only for triglycerides and vitamin D. Both factors may explain up to 62.5% of the change in the IIEF5 score. In conclusion, a relationship between vitamin D (25(OH)D) serum levels and ED may be confirmed in this study as a statistically significant positive correlation was proved. The level of 25(OH)D was proportional with the severity of ED, as well as, the nature of response to sildenafil treatment. Therefore, it may be suggested that vitamin D could be used as a marker for the severity of the ED and moreover, as a predictor for the possible response to sildenafil therapy in patients with ED due to vascular disorder. Even, it may be more beneficial than using PPDU.