Ureterolithiasis: There’s a Better Way

Much as been made of a debate over the efficacy of tamsulosin.  Once in favor, espoused by urologists the world ‘round – but now the subject of multiple neutral, high-quality, trials.

But, what if I told you there might be a better way?

This prospective, randomized trial enrolled male patients with distal ureterolithiasis into three arms: symptomatic care-only control, daily tamsulosin, or a prescription for sexual intercourse at least three times a week.  Furthermore, patients in the symptomatic care arm and tamsulosin arms were forbidden from real or simulated sexual relations for the duration of the study.  Stone presence was confirmed by plain x-ray, and passage confirmed by correlating patient report of stone passage with absence of stone on follow-up x-ray.

As you’ve probably already gleaned from the build-up, the sexual intercourse group was the clear winner.  Mean stone size was 4.7 to 5mm across groups, so these were fairly large stones.   83% of the intercourse group had stone passage within 2 weeks, compared with 48% of tamsulosin and 35% of control.  By the end of follow-up, the other two groups had improved – but still hadn’t entirely caught up.

Unfortunately, there were only 90 total patients in this trial – and 15 were lost to follow-up.  There was no mechanism in place to confirm compliance with the treatment protocol.  Finally, of course, patients could not be blinded to treatment allocation, and no placebo for tamsulosin was provided to other groups.

Presumably, this is a low-cost, low-harm treatment intervention – and there’s some reasonable physiologic basis for the observed effect.  It may be a bit of brilliance – or, at the minimum, it might be worth an IgNobel prize?

“Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study”
https://www.ncbi.nlm.nih.gov/pubmed/26142575