Pharmacologic lithotripsy is very commonly used in ureteral calculi, and these drugs reduce smooth muscle tone, mainly by blocking calcium channels or inhibiting α1 receptors, such as tamsulosin. It has also been shown that nitric oxide (NO) can relax the ureter in the inner segment of the bladder wall, and that the main neurotransmitter in erection and sexual intercourse is NO. It is interesting to know whether sexual activity, or NO produced during sexual activity, can promote the expulsion of stones? Dr. Doluoglu et al. from the Clinic of Ankara Training and Research Hospital in Turkey conducted a prospective randomized controlled study to explore the effect of sexual activity on the spontaneous expulsion of distal ureteral stones. The results showed that in patients with ≤ 6 mm distal ureteral stones, sexual activity 3-4 times per week promoted spontaneous stone expulsion. The article was published in a recent issue of Urology. The study included 90 male patients with distal ureteral stones who were randomized into 3 groups: the first group had 3-4 sexual activities per week; the second group was treated with tamsulosin 0.4 mg/d; and the third group was treated symptomatically only and served as a control group. All patients received oral antispasmodic 10 mg bid and diclofenac 75 mg as needed. 2 and 3 groups were excluded from sexual activity during the study period. 2 and 4 weeks later, stone expulsion rates were counted. 09-01 08:40 Source: Clove Garden Author: Tang The results showed that stone sizes in the three groups were 4.7±0.8, 5±1 and 4.9±0.8 mm, respectively. After 2 weeks, the spontaneous stone expulsion rate was 83.9% in the sexually active group and 47.6% and 34.8% in the other two groups, respectively. The mean time to stone expulsion was 10±5.8, 16.6±8.5, and 18±5.5 days in the three groups, and the number of pain medications used was 1.04±0.5, 1.8±1.1, and 2.3±1.04, respectively. no treatment-related adverse events were observed during follow-up. NO is a common non-adrenergic, non-cholinergic inhibitory neurotransmitter in the central and peripheral nervous system. Numerous studies have shown that NO can relax the ureter in the inner segment of the bladder wall, and NO is also a major neurotransmitter in erection and sexual activity. During sexual intercourse, stimulation of the cavernous nerves of the penis activates nitrophilic nerve fibers, which release NO. However, the type of nerve stimulation transmitted to the ureter during intercourse is unknown. The hypothesis that the distal ureter can be stimulated by non-adrenergic, non-cholinergic (nitrophilic) nerve endings during intercourse is supported by the higher rate of stone discharge in the sexually active group of this study. Currently, MET as first-line treatment for ureteral stones may reduce the need for unnecessary surgical treatment. Based on the results of the study, the authors concluded that in patients with ≤ 6 mm distal ureteral stones, sexual activity at least 3 times per week increases the likelihood of spontaneous stone expulsion and reduces the time to stone expulsion.