The combination of electrotherapy with pelvic floor muscle training in the treatment of a patient with postcovid erectile dysfunction. Clinical case

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Demyelinating inflammation of the pudendal nerve associated with COVID-19 has been clinically identified in many cases and has been proven in animal experiments. Many authors associate the development of erectile dysfunction after suffering COVID-19 with endothelial disorders in the urethra and other endocrine and psychological disorders.

In clinical practice, after the start of the COVID-19 pandemic, we have identified many cases of erectile dysfunction with confirmed neurophysiological and clinical disorders of the pudendal nerve. Despite active medical treatment, not all patients improve. In this regard, we decided to demonstrate this clinical case. The patient underwent a course of pelvic floor muscle training and transcutaneous electrical neurostimulation after the lack of effect of pharmacotherapy.

The diagnosis of erectile dysfunction against the background of damage to the pudendal nerve as a result of a history of COVID-19 was established on the basis of the patient’s complaints, anamnesis, clinical picture, biochemical, neuroimaging and neurophysiological methods of research. Before treatment, the pain syndrome was 7/10 points, the strength of the pelvic floor muscles was 2/5 points, the erectile function according to the erectile function index was 8/30 points and the quality of life as a result of erectile dysfunction was 46/60 points. The use of transcutaneous electrical nerve stimulation of the pudendal nerve in combination with training of the pelvic floor muscles proved to be very effective in the treatment of patients with severe pudendal neuralgia accompanied by severe erectile dysfunction, weakness of the pelvic floor muscles and impaired urination. Against the background of debilitation, the pain syndrome regressed by 78%, erectile dysfunction decreased by 2 times, the quality of life improved by 82.6% and the strength of the pelvic floor muscles increased by 75% and urination disorders completely regressed.

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作者简介

Mustafa Al-Zamil

Peoples’ Friendship University of Russia; Medical Dental Institute; Brain and Spine Clinic “Olivia”

编辑信件的主要联系方式.
Email: alzamil@mail.ru
ORCID iD: 0000-0002-3643-982X
SPIN 代码: 3434-9150

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow; Moscow; Podolsk

Denis Zalozhnev

Medical Dental Institute

Email: olivia4967@mail.ru
ORCID iD: 0000-0001-8976-3378
俄罗斯联邦, Moscow

Natalya Kulikova

Peoples’ Friendship University of Russia; National Medical Research Center of Rehabilitation and Balneology

Email: kulikovang777@mail.ru
ORCID iD: 0000-0002-6895-0681
SPIN 代码: 1827-7880

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow; Moscow

Ekaterina Vasilieva

Petrovsky National Research Centre of Surgery; Russian University of Medicine

Email: e_vasilieva@inbox.ru
ORCID iD: 0000-0003-3087-3067
SPIN 代码: 5423-8408

MD, Dr. Sci. (Med.)

俄罗斯联邦, Moscow; Moscow

参考

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  10. Mumm JN, Osterman A, Ruzicka M, et al. Urinary frequency as a possibly overlooked symptom in COVID-19 patients: Does SARS-CoV-2 cause viral cystitis? Eur Urol. 2020;78(4):624-628. doi: 10.1016/j.eururo.2020.05.013
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2. Fig. 1. Male, 20 years old. Left axillary vein thrombosis on the background of COVID-19. Swelling and lividity of the left arm. He was under the supervision of a neurologist with suspicion of left-sided brachial plexopathy. Blue lines indicate areas for measuring the diameters of the forearms at different levels. Red arrows indicate the diameters of the left forearm at different levels. The same arrows were installed on the right forearm as on the left, with the same dimensions. As you can see, the arrow extends beyond the boundaries of the right forearm, this indirectly reflects how much the volume of the left forearm exceeds the right.

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3. Fig. 2. The genital nerve is formed by the plexus of roots S2, S3 and S4. The pelvic floor muscles (m. levator ani, m. sphincter ani ext.) are innervated by the S4 root.

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4. Fig. 3. Magnetic resonance imaging of the lumbosacral spine (sagittal projection) in T2 mode shows two medial intervertebral disc protrusions at L4–L5, L5–S1 of moderate size (arrows).

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5. Fig. 4. Needle electromyography of the m. bulbocavernosus on the left.

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6. Fig. 5. Needle electromyography of the m. bulbocavernosus on the right.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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