Is Sexual Activity an Effective Way to Expel Distal and Intramural Ureteral Stones? An Updated Systematic Review and Meta-analysis

Abstract

Purpose: Ureterolithiasis is a prevalent condition with a high morbidity, typically causing incapacitating pain and, if not treated correctly, can lead to renal failure. This research has sought to investigate the link between sexual activity, including masturbation, and a higher rate of spontaneous expulsion of ureteral stones. Material and Methods: We searched PubMed, Embase, and Cochrane for randomized clinical trials (RCT) assessing the effectiveness of sexual activity or masturbation in the elimination of distal or intramural ureteral stones. Heterogeneity was assessed with I². Values of p < 0.05 were considered statistically significant. Statistical analysis was performed using Review Manager 5.4.1 (Cochrane Center, The Cochrane Collaboration). Results: We included 8 RCTs, totaling 755 patients, of which 383 (50.7%) engaged in sexual activity or masturbation 3-4 times per week for an average duration of 4 weeks. The expulsion rate at 2 weeks (OR: 3.48; [95% CI: 2.37 to 5.11]; p < 0.00001) and at 4 weeks (OR: 3.28; [95% CI: 2.23 to 4.83]; p < 0.00001) was higher in the sexual activity or masturbation group. The average time for stone expulsion (MD: -3.27; [95% CI: -5.38 to -1.17]; p < 0.002) was shorter in the experimental group, as well as the average number of analgesic injections (MD: -0.6; [95% CI: -0.91 to -0.29]; p < 0.0001). Conclusion: Our findings suggest that sexual activity or masturbation appears to be effective as an expulsive medical therapy for patients with distal or intramural ureteral stones.