Comparison of the Efficacy of Male Sexual Activity Versus Alpha-Blockers in the Expulsion of Distal Ureteric Stones: A Systematic Review and Meta-Analysis

Abstract

Globally, the prevalence of urolithiasis is increasing, with limited effective treatment options. Though debate exists within the literature, the use of medical expulsive therapy (MET) for distal ureteric stones in the form of alpha-blockers is commonplace. Alpha-blockers work via the inhibition of norepinephrine, resulting in a small degree of distal ureteric relaxation. Nitric oxide (NO), the main neurotransmitter involved in penile erection, causes smooth muscle relaxation of the distal ureter. It is hypothesised that these alternative pathways may achieve the same desire clinical effect. To our knowledge, this is the first meta-analysis comparing the efficacy of male sexual activity, in the form of intercourse or masturbation, to alpha-blockers in the expulsion of ureteric stones. We conducted a comprehensive search of electronic databases (PubMed, MEDLINE, EMBASE, SCOPUS, CENTRAL and Google Scholar), identifying studies comparing male sexual activity versus alpha-blockers, in male patients with distal ureteric stones. The Cochrane risk-of-bias tool was used to assess the included studies. For data analysis, a random effects model was used in the event of significant heterogeneity (>75%), with fixed-effects modelling in the event of low-moderate heterogeneity. A search of electronic databases found three randomised control trials (RCTs), enrolling a total of 262 patients. There was no statistically significant difference observed when patients engaged in sexual activity rather than alpha-blocker, when looking at stone expulsion rate at two weeks (P=0.36), expulsion rate at four weeks (P=0.57), or the mean stone expulsion time (P=0.21). Furthermore, there was no significant difference observed when looking at analgesic requirements (P=0.43), or the requirement for additional procedures (P=0.57). Our meta-analysis demonstrated that male sexual activity as an alternative therapy for distal ureteric stones had comparable outcomes to the use of alpha-blocker, proving a viable alternative therapy in those patients wishing to avoid pharmacological management.

Efficacy of sexual intercosurse in the spontaneous passage of distal or intramural ureteral stones: a randomsized controlled trial

“…Furthermore, tamsulosin may not be a favorable choice for men who wish to avoid medication and its associated side effects, such as retrograde ejaculation (experienced by 8–18% of users), as well as orthostatic hypotension, headache, dizziness, and diarrhea. Prior use of tamsulosin can also complicate cataract surgery by causing floppy iris syndrome 4 .…”

“…Among all urinary stones, ~20% can be located in the ureter, while 70% are found in the distal ureteric segment 2 , 3 . The escalating burden of kidney stone disease has substantial costs for healthcare systems, and the disease also has a negative impact on the patient’s quality of life 4 . There is a 50% chance of distal UTS spontaneously passing via conservative treatment within a 6-week period 3 .…”

Role of Increased Sexual Activity in Expulsion of Distal Ureteral Stone Size 5 to 10 mmiIn Married Male

“…However substantial amount of literature is lacking on this new modality of management. In one systematic metanalysis review by Chaolo HC Juman et.al, found that increased sexual activity (thrice a week) is comparable to a-blocker in expulsion of distal ureteral stone size up to 10 mm especially those patients who are reluctant to pharmacological treatment 10 . In an another randomized controlled trial by Liw, Mao-Y et.al, concluded that at least 3 sexual intercourse per week after SWL can effectively increase the stone passage rate, decrease the formation of steinstrasse and the relief of renal colic 11 .…”