Özsoy M. et al., 2019: Sex differences in the therapy of kidney and ureteral stones
Özsoy M, Somani B, Seitz C, Veser J, Kallidonis P.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital.
Urology and Andrology, Karl Landsteiner Society, Vienna, Austria.
University Hospital Southampton NHS Trust.
University of Southampton, Southampton, UK.
Department of Urology, University of Patras, Patras, Greece
Better understanding of sex differences affecting urolithiasis may help us offer tailored treatment strategies to our patients. RECENT FINDINGS: The incidence of urolithiasis is increasing and the male-to-female ratio has decreased from 3 : 1 to 1.3 : 1 between 1970 and 2000. In women, obesity has a larger effect on the risk of developing urolithiasis [odds ratio (OR) 1.35; 95% confidence interval (CI): 1.33-1.37] compared with men (OR 1.04; 95% CI: 1.02-1.06). Urolithiasis is a risk factor for coronary artery disease in men (risk ratio = 1.23; 95% CI: 1.02-1.49) and for stroke in women (risk ratio = 1.12; 95% CI: 1.03-1.21). Women tolerate cystoscopic stent removal and shock wave lithotripsy better than men. For shock wave lithotripsy menopaused women have reported lower visual analog scale scores than menstruating women (P < 0.001). Female sex was an independent predictor of stone impaction (OR 1.15; 95% CI: 1.03-1.27) and postoperative sepsis after ureteroscopy (OR 2.31; 95% CI: 1.14-4.37). SUMMARY: The sex gap in urolithiasis is closing. The changing role of women in society and dietary habits can be responsible for this epidemiologic shift. Women show a higher threshold for pain during urologic procedures, but they suffer from infectious complications more than men. Urolithiasis is a risk factor for cardiovascular events in both sexes.
Curr Opin Urol. 2019 Mar 6. doi: 10.1097/MOU.0000000000000604. [Epub ahead of print]
This is an interesting collection of references on male/female differences but also an easy mixture of casual and causal relations. If women had a long curved urethra like men, they would probably not tolerate cystoscopy and stent removal better than men would. Only one reference on ESWL and gender related differences in pain perception is widely incomplete, there are more (1,2,3, ...).
To further study these interesting aspects the authors should cooperate with colleagues from Ankara, Turkey who studied the influence of intercourse on stone passage unfortunately only on male patients (4).
1 Berwin JT, El-Husseiny T, Papatsoris AG, Hajdinjak T, Masood J, Buchholz N (2009) Pain in extracorporeal shock wave lithotripsy. Urol Res 37(2):51–53
2 Altok M, Akpinar A, Güneş M, Umul M, Demirci K, Baş E (2016) Do anxiety, stress, or depression have any impact on pain perception during shock wave lithotripsy?. Can Urol Assoc J 10(5–6) 171-174;
3 Ktari K, Saidi R, Mahjoub M, Hamdouni W, Macherki S, Ben khalifa B. Saad H. (2015). Quels sont les facteurs prédictifs de la douleur lors du traitement des calculs rénaux par lithotritie extracorporelle ? Progrès En Urologie, 25(12), 698–704;
4 Doluoglu OG, Demirbas A, Kilinc MF, Karakan T, Kabar M, Bozkurt S, Resorlu B. Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study. Urology. 2015 Jul;86(1):19-24.