Is sexual activity an effective way to expel distal and intramural ureteral stones? An updated systematic review and meta-analysis

Abstract Purpose The influence of sexual activity on the spontaneous passage of ureteral stones has been tested by several randomized controlled trials (RCTs), but this relationship remains uncertain. 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 RCTs, in January 2024, assessing the effectiveness of sexual activity or masturbation in the elimination of distal or intramural ureteral stones in patients who didn’t receive medical expulsive therapy. Heterogeneity was assessed with I 2 . 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.