43RD VIRTUAL ANNUAL SCIENTIFIC MEETING OF INDONESIAN UROLOGICAL ASSOCIATION 2020

Alleviating Pain with Pleasure: A Systematic Review and

Meta-Analysis of Randomized Clinical Trials Evaluating
The Efficacy of Sexual Intercourse for Distal Ureteral Calculi
Yudhistira Pradnyan Kloping, Furqan Hidayatullah, Zakaria Aulia Rahman, Lukman Hakim
Urology Department, Universitas Airlangga-Dr. Soetomo Hospital, Surabaya, East Java, Indonesia

BACKGROUND AND AIM

Distal ureter is the most common location for ureteral calculi. The location allows for spontaneous passage with only symptomatic
treatments. Several studies discovered that nitric oxide release during sexual intercourse may lead to distal ureteric relaxation.
Moreover, bladder neck contraction followed by relaxation may occur during orgasm and ejaculation, leading to passage of
stones. We aimed to evaluate the efficacy of sexual intercourse for distal ureteral calculi by performing an updated meta-analysis
of relevant randomized controlled trials (RCT)s.

METHODS RESULTS
A comprehensive literature search was performed Five RCTs consisting of 236 samples from the control group
through the electronic databases including Embase, and 243 samples from the treatment group were analyzed.
Scopus, and Medline. Four trials assigned sexual intercourse as a primary
The articles were assessed using the Cochrane Risk of treatment and one trial assigned it as an adjuvant to shock
Bias (RoB) 2 tool for randomized trials. wave lithotripsy (SWL).
The measured outcomes were: analgesics requirement, Favorable results toward the sexual intercourse group can be
stone expulsion time, and stone expulsion rate (SER) seen in analgesics requirements, stone expulsion time,
during the second and fourth week. and stone expulsion rate in both the 2nd and 4th week as
Mean difference (MD) between the control and treatment well as the stone expulsion rate analysis which includes SWL
group was analyzed using Review Manager. as an intervention before sexual intercourse.

Treatment Sample size Averege stone size

Study Year Comparison Follow-up
regimen Control Treatment Control Treatment

Sexual Intercourse 3-4

Symptomatic 41 41 6.67 7.01 2 weeks and 4
Turgut 2020 times/week and symptomatic
treatment only patients patients mm mm weeks
treatment
Sexual intercourse 3 times/week Consuming enough
68 70 11.9 11.1 1 week and 2
Li et al 2020 after Shock Wave Lithotripsy (SWL) fluids after SWL
treatment patients patients mm mm weeks
treatment of 3000 shocks/session
Sexual Intercourse 3
Bayraktar 2017 times/week and Symptomatic 64 66 11.9 11.1 2 weeks and 4
et al symptomatic treatment
treatment only patients patients mm mm weeks

Sexual Intercourse 3-4

Abdel- Symptomatic 33 33 7.03 6.69 2 weeks and 4
Kader et al 2017 times/week and
treatment only patients patients mm mm weeks
symptomatic treatment

Doluoglu 2015
Sexual Intercourse 3 Symptomatic 30 33 4.7 4.9 2 weeks and 4
et al times/week treatment only patients patients mm mm weeks

SER with ESWL study included, OR 4.46, 95% CI 2.72 to 7.29, p < 0.00001 (2nd week)

STONE EXPULSION TIME, MD -3.98, 95% CI-7.32 to -0.64, p = 0.02

SER without ESWL, OR 5.78, 95% CI 3.45 to 9.68, p < 0.00001 (2nd week)

ANALGESICS REQUIREMENTS, MD -0.76, 95% CI -1.27 to -0.26, p = 0.003

SER without ESWL, OR 4.00, 95% CI2.27 to 7.04, p < 0.00001 (4th week)

CONCLUSION
Performing sexual intercourse three to four times per week is beneficial to alleviate pain, thus reducing the need for
analgesics administration.
It is able to shorten stone expulsion time and increase stone expulsion rate as a standalone treatment as well as an
adjunct to SWL.

REFERENCES
1. Turgut H. Evaluation of the efficacy of sexual intercourse on distal ureteral stones in women: a prospective, randomized, controlled study. Int Urol Nephrol. 2020.
2. Li W, Mao Y, Lu C, Gu Y, Hua B, Pan W. Role of sexual intercourse after shockwave lithotripsy for distal ureteral stones: A randomized controlled trial. Urol J. 2020;17(2): 134–8.
3. 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. 2017;49(11):1941–6.
4. Abdel-Kader MS. Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones. Int Urol Nephrol. 2017;49(1):27–30.
5. Doluoglu OG, Demirbas A, Kilinc MF, Karakan T, Kabar M, Bozkurt S, et al. Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study. Urology. 2015;86(1):19–24.