Efficacy of transcutaneous electroneurostimulation in treatment of erectile dysfunction associated with Covid-19

Abstract

Background: Many studies provide data on the development of erectile dysfunction in patients after COVID-19. In most cases, the authors associated this complication with depression. However, in rare cases, erectile dysfunction is organic in nature as a result of pudendal neuropathy. Materials and methods: We examined 29 patients with the development of sexual erectile dysfunction after COVID-19. In all patients, entrapment of the pudendal nerve was detected using pudendal evoked potentials and needle electromyography of pelvic floor. All patients underwent standard medical therapy for the treatment of sexual dysfunction after recovery from COVID-19. In addition to drug therapy, 9 patients underwent TENS of the pudendal nerve using monophasic square wave pulses with a frequency of 1 Hz and a duration of 100 μs with small amplitude below the threshold of sensory fibers (sham-TENS group). 10 patients underwent the same impulses with a frequency of 1 Hz and a duration of 100 μs with amplitude higher threshold level of sensory fibers (low-frequency TENS group), and 10 patients underwent TENS with frequency of 100 Hz and duration of 100 μs with amplitude higher threshold level of sensory fibers (high-frequency TENS group). International Index of Erectile Function questionnaire, QLS-H (Questions on Life Satisfaction), pudendal somatosensory evoked potentials, and needle electromyography of pelvic floor were used before and after treatment. Results: In patients after direct TENS of the pudendal nerve, erectile function improved in high-frequency TENS group and in low-frequency TENS group by 56 % and 27 % respectively. A remarkable increase in the quality of life satisfaction was noted by 95 % of patients after high-frequency TENS and by 35 % of patients after low-frequency TENS. There were no significant changes in erectile function and quality of life satisfaction in patients after sham stimulation. Partial recovery of latency and amplitudes of pudendal somatosensory evoked potentials N1 N2 was recorded in 6 patients only after high-frequency TENS. Conclusion: Direct high-frequency TENS of pudendal nerve is highly effective in treatment of erectile dysfunction associated with COVID-19. The high-frequency TENS proved 2 times more efficient than the low-frequency TENS. Notably, positive neurophysiological dynamics, determined using needle electromyography of the pelvic floor and pudendal somatosensory evoked potentials, was detected only against the background of high-frequency TENS.