الفهرس 
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Abstract
Erectile dysfunction was defined by the Consensus Panel of the National Institute of Health (NIH), USA, as the inability of the male to attain and/or maintain a penile erection sufficient for satisfactory
sexual performance.
Causes of erectile dysfunction are numerous but generally fall in two categories: organic and psychogenic; the organic causes can be further subdivided into many categories ( vascular, neurological and endocrinal).there are many investigative tool in addition to history to
reach the diagnosis.
Treatment of erectile dysfunction includes psychotherapy, oral and pharmacological agents, external devices and lastly penile
prosthesis.
For many men who seek medical advice for erectile dysfunction the ideal therapy would be oral medication, probably involving a short course of tablets which would effectively restore sexual function to normal. This therapy would be rapidly acting, effective, simple to use and safe.
In March 1998, sildenafil (Viagra), the first safe and effective oral agent for the treatment of ED, was approved. Sildenafil is an orally active inhibitor of phosphodiesterase-5 (PDE-5), this agent therefore promotes erection by inhibiting the degradation of cGMP. Increasing cGMP levels promote and amplify the relaxation of
Benha faculty of medicine -204- 2003
Zagazig university
cavernosal smooth muscle that occurs after sexual arousal, thereby facilitating the erectile response.
Apomorphine SL (Uprima) is a new sublingual formulation of apomorphine HC1 for the first-line therapy of ED. which is a central dopamine agonist that enhances central neural output to induce
erection
Apomorphine SL stimulates dopamine D2 receptors mainly in the paraventricular nucleus of the hypothalamus which, in turn, activate pro-erectile central neurological pathways involving nitric oxide, resulting in penile erection.
Apomorphine SL is fast-acting and effective in restoring erectile function .Detectable concentrations are found in plasma typically within 10 min of dosing, producing a clinical response (erection) within 18-19 min, with sexual stimulation.
The aim of the present work is to carry out a comparative study between the effect of SL sildenafil 50mg, SL apomorphine 3mg and combination of sildenafil and apomorphine SL on male patients with erectile dysfunctions.
The current study is double-blind, placebo-controlled, cross-over, fixed dose and clinical trial study, done on 60 patients complaining of erectile dysfunction with age range from 25 to 65
years.
Benha faculty of medicine -205- 2003
Zagazig university
All patients are subjected to the following:
1.Full history.
2.Full clinical examination.
3.Several laboratory and procedure investigations.
According to history and investigations, the patients classified into two groups: organic 24 and psychogenic 36
Each patient was given:
•In the 1st visit, drug (1) which was SL sildenafil citrate 50mg.
•In the 2nd visit, drug (2) which was SL apomorphine 3mg.
•In the 3rd visit, drug (3) which was combination of sildenafil citrate 50mg and apomorphine 3mg.
•In the 4th visit, drug (4) which was placebo.
The interval between each visit is one week.
The results were evaluated by using International Index of Erectile Function (IIEF-5).
This study had shown a high statistically significant better improvement to sublingual combination than sildenafil and apomorphine with P = 0.003 and P < 0.001 respectively as well as sildenafil shows high significant improvement than apomorphine with p = 0.001.
Benha faculty of medicine -206- 2003
Zagazig university
As regard to causes, in psychogenic patients the sublingual combination show also a high statistically significant improvement
than sildenafil and apomorphine with P=0.043 and P<0.001 respectively as well as sildenafil shows high significant improvement
than apomorphine with p = 0.002.
While in organic patients the sublingual combination show
statistically significant improvement than sildenafil and
apomorphine with p=0.012 and p=0.002 respectively but there is no significant improvement between sildenafil and apomorphine with
P=0.158.
The reported side effects of all drug therapy were mild and did
not lead to stoppage of drug administration.