Sexual Intercourse May Clear Distal Ureteral Stones

Having sex 3-4 times a week was associated with a significantly greater stone passage rate than tamsulosin or standard medical therapy.
Having sex 3-4 times a week was associated with a significantly greater stone passage rate than tamsulosin or standard medical therapy.

Sexual intercourse may be an effective way to clear distal ureteral stones, researchers have concluded.

Omer Gohhan Doluoglu, MD, and colleagues at the Clinic of Ankara Training and Research Hospital in Ankara, Turkey, randomly assigned 90 male patients with distal ureteral stones to 1 of 3 treatment arms: sexual intercourse 3–4 times a week (group 1); tamsulosin 0.4 mg/day (group 2); and standard medical therapy (controls, group 3). The mean stone size was similar among the groups: 4.7, 5.0, and 4.9 mm in groups 1, 2, and 3, respectively. Of the 90 patients, 15 were excluded because of loss to follow-up.

After 2 weeks, 26 (83.9%) of 31 patients in the sexual intercourse group passed their stones compared with 10 (47.6%) of patients in the tamulosin group and 8 (34.8%) of patients in the control arm, according to a report in Urology (2015;86:19-24). The difference in stone passage rate was significantly greater in group 1 versus the other groups.

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The mean stone expulsion time was significantly shorter in group 1 compared with the other groups: 10 days in group 1 versus 16.6 days in group 2, and 18 days in group 3.

The investigators postulate that nitric oxide released during erection and sexual intercourse may affect the distal ureters, causing relaxation of ureteral muscle.

"Today, MET [medical expulsive therapy] is recommended as the first-line treatment in ureteral stones that do not necessitate surgery," the authors concluded. "In our opinion, if the patient has a sexual partner, having sexual intercourse at least 3 times a week may be beneficial to increase the probability of spontaneous stone expulsion in patients with distal ureteral stones ≤6 mm in size."

In an accompanying editorial (p.24), Jeffrey J. Tosoian, MD, MPH, of Johns Hopkins Medical Institutions in Baltimore, commented that the study by Dr. Doluoglu's group "has great value in again bringing to light the potential role of the nitric oxide pathway in treatment of stone disease."

Dr. Tosoian cited previous studies that have identified nitrergic fibers in the distal ureter and demonstrated a relaxant effect of nitric oxide on ureteral smooth muscle.

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