Editorial Comment

Abstract

The prevalence of urolithiasis in the United States has steadily increased over the past several years. 1 Scales Jr., C.D. Smith A.C. Hanley J.M. et al. Prevalence of kidney stones in the United States. Eur Urol. 2012; 62: 160 Abstract Full Text Full Text PDF PubMed Scopus (1468) Google Scholar The morbidity caused by stone disease is similarly significant, as 30% of patients diagnosed with stone disease report loss of work associated with the diagnosis. 2 Pearle M.S. Calhoun E.A. Curhan G.C. et al. Urologic diseases in America project: urolithiasis. J Urol. 2005; 173: 848 Abstract Full Text Full Text PDF PubMed Scopus (627) Google Scholar Furthermore, when medical expulsive therapy is unsuccessful, procedural intervention often presents a significant financial burden to both the patient and practice. 3 Tosoian J.J. Ludwig W. Sopko N. et al. The effect of repair costs on the profitability of a ureteroscopy program. J Endourol. 2015; 29: 406-409 Crossref PubMed Scopus (31) Google Scholar As such, and in light of health care reform with greater focus on financial responsibility, the potential therapeutic effect of lifestyle modifications such as diet and exercise remains an important consideration. 4 Hyams E.S. Matlaga B.R. Cost-effectiveness treatment strategies for stone disease for the practicing urologist. Urol Clin North Am. 2013; 40: 129 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar In the accompanying article, Doluoglu et al 5 Doluoglu O.G. Demirbas A. Kilinc M.F. et al. Can sexual intercourse be an alternative therapy for distal ureteral stones? A prospective, randomized, controlled study. Urology. 2015; 86: 19-24 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar hypothesize that sexual intercourse may facilitate the passage of distal ureteral stones via a nitric oxide–mediated pathway. Specifically, the authors propose that nitric oxide released in high concentrations in cavernous tissue during erection and intercourse may be released in the distal ureter as well, triggering relaxation of ureteral muscle. Indeed, previous studies have identified nitrergic fibers in the distal ureter and demonstrated a relaxant effect of NO on ureteral smooth muscle. 6 Yucel S. Baskin L.S. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol. 2003; 170: 945 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 7 Iselin C.E. Ny L. Larsson B. et al. The nitric oxide synthase/nitric oxide and heme oxygenase/carbon monoxide pathways in the human ureter. Eur Urol. 1998; 33: 214 Crossref PubMed Scopus (26) Google Scholar Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled StudyUrologyVol. 86Issue 1PreviewTo investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones. Full-Text PDF