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Sexual intercourse as a new option in the medical expulsive therapy of distal ureteral stones in males: a prospective, randomized, controlled study

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To investigate the effect of sexual intercourse on the spontaneous passage of distal ureteral stones 5–10 mm in size.


A total of 190 male patients with distal ureteral stones were randomly divided into three groups. Patients in group 1 were administered tamsulosin 0.4 mg/day (n = 60). Patients in group 2 were asked to have sexual intercourse at least three times a week (n = 66). Patients in group 3 received standard medical therapy alone and acted as the controls (n = 64). The expulsion rate was controlled after 2 and 4 weeks. Differences between the groups were analyzed statistically by the Chi-square and Student’s t test. p < 0.05 was considered as statistically significant.


The mean ages of the patients in groups 1, 2, and 3 were 34.4 ± 13.5 (18–60), 38.6 ± 14.1 (18–63), and 36.92 ± 12.4 (18–59) years, respectively (p > 0.05). The mean stone size was 7.09 ± 1.4 mm in group 1, 7.01 ± 1.4 mm in group 2, and 7.1 ± 1.3 mm in group 3 (p > 0.05). Spontaneous passage rates in groups 1, 2, and 3 were 81.6, 81.8, and 51.5%, respectively, and it was significantly higher in group 1 (p = 0.0394) and group 2 (p = 0.0350). There was no significant difference between groups 1 and 2 (p = 0.9925). The analgesic needs in groups 1, 2, and 3 were found to be 1.3 ± 0.4, 1.2 ± 0.6, and 1.4 ± 0.4 times, respectively, and were significantly lower in the sexual intercourse group than in the control group (p = 0.0276).


Tamsulosin and sexual intercourse increase the spontaneous passage of distal ureteral stones 5–10 mm in size. At least three sexual intercourses per week seem to be at least as effective as tamsulosin. Sexual intercourse also reduces the need for analgesics in ureteric colic due to ureteral stones.

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  1. Scales CD Jr, Smith AC, Hanley JM, Saigal CS (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165. doi:10.1016/j.eururo.2012.03.052

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ordon M, Andonian S, Blew B, Schuler T, Chew B, Pace KT (2015) CUA, guideline: management of ureteral calculi. Can Urol Assoc J 9(11-12):E837–E851. doi:10.5489/cuaj.3483

    Article  PubMed  PubMed Central  Google Scholar 

  3. Singh A, Alter HJ, Littlepage A (2007) A systematic review of medical therapy to facilitate passage of ureteral calculi. Ann Emerg Med 50:552–563

    Article  PubMed  Google Scholar 

  4. Loftus C, Nyame Y, Hinck B et al (2016) Medical expulsive therapy is underused for the management of renal colic in the emergency setting. J Urol 195(4 Pt 1):987–991. doi:10.1016/j.juro.2015.11.026

    Article  PubMed  Google Scholar 

  5. Brede C, Hollingsworth JM, Faerber GJ, Taylor JS, Wolf JS Jr (2010) Medical expulsive therapy for ureteral calculi in the real world: targeted education increases use and improves patient outcome. J Urol 183:585–589

    Article  PubMed  Google Scholar 

  6. Turk C, Petrik A, Sarica K et al (2016) EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 69(3):468–474. doi:10.1016/j.eururo.2015.07.040

    Article  PubMed  Google Scholar 

  7. Bensalah K, Pearle M, Lotan Y (2008) Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol 53:411–418

    Article  PubMed  Google Scholar 

  8. Miller OF, Kane CJ (1999) Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 162:688–691

    Article  CAS  PubMed  Google Scholar 

  9. Preminger GM, Tiselius HG, Assimos DG et al (2007) 2007 guideline for the management of ureteral calculi. Eur Urol 52:1610–1613

    Article  PubMed  Google Scholar 

  10. Sasaki S, Tomiyama Y, Kobayashi S, Kojima Y, Kubota Y, Kohri K (2011) Characterization of α1-adrenoceptor subtypes mediating contraction in human isolated ureters. Urology 77(762):13–17

    Google Scholar 

  11. Zhou SG, Lu JL, Hui JH (2011) Comparing efficacy of a1D receptor antagonist naftopidil and a1A/D-receptor antagonist tamsulosin in management of distal ureteral stones. World J Urol 29:767–771

  12. Al-Ansari A, Al-Naimi A, Alobaidy A, Assadiq K, Azmi MD, Shokeir AA (2010) Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urology 75(1):4–7. doi:10.1016/j.urology.2009.09.073

    Article  PubMed  Google Scholar 

  13. Ye Z, Yang H, Li H et al (2011) A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. BJU Int 108:276–279

    Article  CAS  PubMed  Google Scholar 

  14. Lojanapiwat B, Kochakarn W, Suparatchatpan N, Lertwuttichaikul K (2008) Effectiveness of low-dose and standard-dose tamsulosin in the treatment of distal ureteric stones: a randomized controlled study. J Int Med Res 36:529–536

    Article  CAS  PubMed  Google Scholar 

  15. Dellabella M, Milanese G, Muzzonigro G (2003) Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol 170(6 Pt 1):2202–2205

    Article  CAS  PubMed  Google Scholar 

  16. Hollingsworth JM, Rogers MA, Kaufman SR et al (2006) Medical therapy to facilitate urinary stone passage: a meta-analysis. The Lancet 368:1171–1179

    Article  Google Scholar 

  17. Doluoglu OG, Demirbas A, Kilinc MF et al (2015) Can sexual intercourse be an alternative therapy for distal ureteral stones? A prospective, randomized, controlled study. Urology 86:19–24

    Article  PubMed  Google Scholar 

  18. Abdel-Kader MS (2017) Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones. Int Urol Nephrol 49(1):27–30. doi:10.1007/s11255-016-1448-z

    Article  PubMed  Google Scholar 

  19. Edyvane KA, Trussell DC, Jonavicius J, Henwood A, Marshall VR (1992) Presence and regional variation in peptide-containing nerves in the human ureter. J Auton Nerv Syst 39:127–137

    Article  CAS  PubMed  Google Scholar 

  20. Prieto D, Simonsen U, Martın J et al (1994) Histochemical and functional evidence for a cholinergic innervation of the equine ureter. J Auton Nerv Syst 47:159–170

    Article  CAS  PubMed  Google Scholar 

  21. Fernandes VS, Hernández M (2016) The role of nitric oxide and hydrogen sulfide in urinary tract function. Basic Clin Pharmacol Toxicol 119(Suppl 3):34–41. doi:10.1111/bcpt.12565

    Article  CAS  PubMed  Google Scholar 

  22. Mastrangelo D, Baertschi AJ, Roatti A, Amherdt M, Iselin CE (2003) Nitric oxide production within rat urothelial cells. J Urol 170:1409–1414

    Article  CAS  PubMed  Google Scholar 

  23. Hedlund P (2005) Nitric oxide/cGMP-mediated effects in the outflow region of the lower urinary tract-is there a basis for pharmacological targeting of cGMP? World J Urol 23:362–367

    Article  CAS  PubMed  Google Scholar 

  24. Lue TF (2000) Erectile dysfunction. N Engl J Med 342(24):1802–1813

    Article  CAS  PubMed  Google Scholar 

  25. Eryildirim B, Sahin C, Tuncer M et al (2015) Effect of medical expulsive therapy on the health-related quality of life of patients with ureteralstones: a critical evaluation. Int Urol Nephrol 47(8):1271–1275. doi:10.1007/s11255-015-1036-7

    Article  PubMed  Google Scholar 

  26. Kumar S, Jayant K, Agrawal MM, Singh SK, Agrawal S, Parmar KM (2015) Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study). Urology 85:59–63

    Article  PubMed  Google Scholar 

  27. Montes Cardona CE, García-Perdomo HA (2017) Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: a systematic review and meta-analysis. Investig Clin Urol 58(2):82–89. doi:10.4111/icu.2017.58.2.82

    Article  PubMed  PubMed Central  Google Scholar 

  28. Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H (2005) The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol 173:2010–2012

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Zeki Bayraktar.

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Both the authors declare that they have no conflict of interest in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Bayraktar, Z., Albayrak, S. Sexual intercourse as a new option in the medical expulsive therapy of distal ureteral stones in males: a prospective, randomized, controlled study. Int Urol Nephrol 49, 1941–1946 (2017).

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