Effects of COVID-19 on Cavernous Smooth Muscle
Condition: Erectile Dysfunction Due to Diseases Classified Elsewhere; Covid19
MeSH terms: COVID-19; Erectile Dysfunction
Study type: Interventional

Summary: 
      The aim of the study is to illuminate the role of COVID-19 in the pathophysiology of erectile
      dysfunction (ED). Nine patients that had COVID-19 and were treated as outpatients were
      classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as
      group 2, and 10 patients who did not have COVID-19 and applied to the urology outpatient
      clinic with ED complaints and had similar clinical characteristics were classified as the
      control group (group 3). Patients underwent diagnostic evaluation including International
      Index of Erectile Function-5 form, penile color Doppler ultrasonography, corpus cavernosum
      electromyography, and fasting serum levels of reproductive hormones (07-11 am). According to
      the results of our study, cavernous smooth muscle damage occurs in patients with COVID-19 and
      it has an important role in the pathophysiology of erectile dysfunction.
    

Detailed description: 
      COVID-19, which is caused by a novel coronavirus Sars-Cov-2, has been affecting people all
      over the world for more than a year and has resulted in many deaths. It can affect almost
      every part of the body and cause diseases including anosmia, hypogonadism, myopathy,
      neuropathy, and vasculitis. Studies have reported that it may cause erectile dysfunction
      (ED), however, its role in the pathophysiology of ED has not yet been fully elucidated.

      Patients aged 20-50 years who applied to the urology outpatient clinic due to ED were
      included in the study. Nine patients that had COVID-19 and were treated as outpatients were
      classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as
      group 2, and 10 patients who did not have COVID-19 and applied to the urology outpatient
      clinic with ED complaints and had similar clinical characteristics were classified as the
      control group (group 3). Patients underwent diagnostic evaluation including International
      Index of Erectile Function (IIEF)-5 form, penile color Doppler ultrasonography (CDUS), corpus
      cavernosum electromyography (cc-EMG), and fasting serum levels of reproductive hormones
      (07-11 am).

      According to penile CDUS results, distribution of vasculogenic pathologies in groups was as
      follows: 33% in group 1, 40% in group 2, and 40% in group 3. According to cc-EMG results, the
      pre-vasoactive drug (VAD) amplitudes of the patients in group 2 were significantly lower than
      those in group 3 (p: 0.005). Moreover, the pre-VAD amplitudes of the patients in group 1 were
      also significantly lower than those in group 3 (p: 0.042). In addition, while the RD values
      of the patients in group 2 were significantly lower than those in group 3, no significant
      difference was observed between other groups. There was no significant difference between the
      groups in terms of hormonal profile.

      Cavernosal smooth muscle damage that occurs due to COVID-19-related endothelial dysfunction
      may disrupt the nutrition of cavernosal tissues. The deterioration of the nutrition of the
      cavernosal tissues may be one of the important reasons for the post-COVID-19 ED. The results
      of our study need to be confirmed with larger studies in which electromyographic as well as
      histopathological examinations are performed.
    

Intervention name(s): corpus cavernosum electromyography
Intervention type(s): Diagnostic Test
Intervention description(s): Cc-EMG was performed by using the cc-EMG module of Ellipse 4 device (Andromeda, Germany), which comprises of a 2-channel electromyography amplifier with a row sampling rate of 16 kHz, filtered sampling rate of 166.67 Hz and a band width of 0.5-30 Hz with the speed of the thermo-writer paper set at 5 mm/s. Measurements of the electrical activity of the corpus cavernosum (EACC) were done for 10 minutes using coaxial needle electrodes during the flaccid state and after intracavernous papaverine (60 mg) injection.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Corpus cavernosum electromyography, penile color Doppler ultrasonography and hormonal examinations were compared between the groups of patients with erectile dysfunction who did not have COVID-19, who were diagnosed with COVID-19 and were treated as outpatients or inpatients.
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Erectile Dysfunction; COVID-19; Electromyography