• Logo
  • SBMUJournals

Role of Sexual Intercourse after Shockwave Lithotripsy for Distal Ureteral Stones: A Randomized Controlled Trial

Wenfeng Li, Yuansheng Mao, Chao Lu, Yufei Gu, Xin Gu, Bao Hua, Weixin Pan



Purpose: To explore whether sexual intercourse is beneficial to the clinical outcome of SWL for ureteral calculi of 7-15 mm in the distal ureter.

Materials and Methods: Between March 2016 and January 2017, 225 patents with a stone (7-15 mm) in distal ureter were randomly divided into three groups after SWL: Group 1 was asked to have sexual intercourse at least three times a week, Group 2 was administered tamsulosin 0.4 mg/d and Group 3 was received standard therapy alone and served as the controls. Stone free rate, time to stone expulsion, pain score at admission, number of hospital visits for pain and steinstrasse were recorded in 2 weeks.

Results: 70 patients in Group 1, 71 patients in Group 2 and 68 patients in Group 3 were enrolled to the study. At the end of the first week and the second week, the stone free rates for Group 1 (68.6%, 80.0%) and Group 2 (69.0%, 81.7%) were approximately the same, but were significantly higher than Group 3 (50.0%, 63.2%) (P = .031, P = .022). The VAS scores of Groups 1 and 2 were slightly higher than those of Group 3 (P = .233). The number of patients in Group 3 who visited the emergency room for pain was significantly higher than in the other two groups (P = .015). At the end of the second week, the incidence of steinstrasse in Groups 1 and 2 was significantly lower (2.9%, 2.8% vs 11.8%) (P = .034).

Conclusion: At least three sexual intercourses per week after SWL can effectively improve the stone free rate, reduce the formation of steinstrasse and relieve renal colic. It provides a choice for urologists in the SWL treatment of lower ureteral calculi.


ESWL; sexual intercourse; ureteral stone


(1) Shoag J, Tasian GE, Goldfarb DS, Eisner BH. The new epidemiology of nephrolithiasis. Adv Chronic Kidney Dis. 2015; 22: 273-8.

(2) Ludwig WW, Matlaga BR. Urinary Stone Disease: Diagnosis, Medical Therapy, and Surgical Management. Med Clin North Am. 2018; 102: 265-77.

(3) Choo MS, Han JH, Kim JK, et al. The transgluteal approach to shockwave lithotripsy to treat distal ureter stones: a prospective, randomized, and multicenter study. World J Urol. 2018; 36:1299-1306

(4) Ozgor F, Tosun M, Kayali Y, Savun M, Binbay M, Tepeler A. External Validation and Evaluation of Reliability and Validity of the Triple D Score to Predict Stone-Free Status After Extracorporeal Shockwave Lithotripsy. J Endourol. 2017; 31: 169-73.

(5) Yamashita S, Kohjimoto Y, Iguchi T, et al. Variation Coefficient of Stone Density: A Novel Predictor of the Outcome of Extracorporeal Shockwave Lithotripsy. J Endourol. 2017; 31: 384-90.

(6) McClain PD, Lange JN, Assimos DG. Optimizing shock wave lithotripsy: a comprehensive review. Rev Urol. 2013; 15: 49-60.

(7) Sridharan K, Sivaramakrishnan G. Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials. Expert Rev Clin Pharmacol. 2018; 11: 291-307.

(8) Amer T, Osman B, Johnstone A, et al. Medical expulsive therapy for ureteric stones: Analysing the evidence from systematic reviews and meta-analysis of powered double-blinded randomised controlled trials. Arab J Urol. 2017; 15: 83-93.

(9) Montes CCE, García-Perdomo HA. Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis. Investig Clin Urol. 2017; 58: 82-9.

(10) Villa L, Buono R, Fossati N, et al. Effects by silodosin on the partially obstructed rat ureter in vivo and on human and rat isolated ureters. Br J Pharmacol. 2013; 169: 230-8.

(11) Roshani H, Weltings S, Dabhoiwala NF, Lamers WH. Pharmacological modulation of ureteric peristalsis in a chronically instrumented conscious pig model: effect of adrenergic and nitrergic modulation. World J Urol. 2016; 34: 747-54.

(12) Sandner P, Tinel H, Affaitati G, Costantini R, Giamberardino MA. Effects of PDE5 Inhibitors and sGC Stimulators in a Rat Model of Artificial Ureteral Calculosis. PLoS One. 2015; 10: e0141477.

(13) Abdel-Kader MS. Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones. Int Urol Nephrol. 2017; 49: 27-30.

(14) Doluoglu OG, Demirbas A, Kilinc MF, et al. Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study. Urology. 2015; 86: 19-24.

(15) 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: 1941-6.

(16) Coptcoat MJ, Webb DR, Kellet MJ, et al. The steinstrasse: a legacy of extracorporeal lithotripsy? Eur Urol. 1988; 14 : 93-5.

(17) Chaussy CG, Tiselius HG. How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis. 2018; 46: 3-17.

(18) Wagenius M, Jakobsson J, Stranne J, Linder A. Complications in extracorporeal shockwave lithotripsy: a cohort study. Scand J Urol. 2017; 51: 407-13.

(19) Yazici O, Tuncer M, Sahin C, Demirkol MK, Kafkasli A, Sarica K. Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors. Int Braz J Urol. 2015; 41: 676-82.

(20) Sarica K, Kafkasli A, Yazici Ö, et al. Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL. Urolithiasis. 2015; 43: 83-8.

(21) Kang HW, Cho KS, Ham WS, et al. Predictive factors and treatment outcomes of Steinstrasse following shock wave lithotripsy for ureteral calculi: A Bayesian regression model analysis. Investig Clin Urol. 2018; 59: 112-8.

(22) Fernandes VS, Hernández M. The Role of Nitric Oxide and Hydrogen Sulfide in Urinary Tract Function. Basic Clin Pharmacol Toxicol. 2016; 119 Suppl 3: 34-41.

(23) Li M, Wang Z, Yang J, et al. Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis. PLoS One. 2015; 10: e0122497.

(24) Suresh KG, Vikash S, Himanshu P, et al. Comparative efficacy of tamsulosin versus tadalafil as medical expulsive therapy for distal ureteric stones. Urol Ann. 2018; 10: 82–6.

DOI: http://dx.doi.org/10.22037/uj.v0i0.5400


  • There are currently no refbacks.