ED
Medical

The prevalence of kidney stones among Americans is expected to increase, it affects 1 out of 10 persons in their lifetime. Also, kidney stones are more common in men than in women. After the formation of a kidney stone, there is a 50% chance of developing another stone within five to seven years. Medical conditions such as obesity, diabetes, and others are associated with a higher chance of developing kidney stones. The symptoms of kidney stones may not be noticed until the stones pass into the ureter from the kidney causing a lot of pain in the back, fever, chills, and nausea. In general, not drinking enough water accounts for 50% of the development of kidney stones in the body, and is recommended to drink 3 liters (3.17 quarts) of water per day to avoid kidney stones.

What are Kidney Stones?

Kidney Stones are hard particles made up of chemicals present in the urine. They are usually present in the interior parts of the kidney where the urine leaves from the kidneys and passes into the urinary bladder. The size of these stones varies from a small grain of sand to the size of a golf ball.

How are Kidney Stones formed?

There are numerous minerals and salts that are dissolved in urine. Kidney stones are often formed when these dissolved minerals are high in the liquids that are being filtered by the kidneys. These stones generally attract other particles and tend to form a bigger structure. These small stones are often eliminated from the body through urine without causing much pain. But some may stay back and cause the blockage of Urine in the Kidney and Ureter which leads to pain.

Kidney Stones occur in different types and colors. Mainly there are four types of stones

1. Calcium Stones
2. Uric Acid Stones
3. Struvite/Infection Stones
4. Cystine Stones

Kidney Stones and Erectile Dysfunction

Kidney stones that are formed in the kidneys move into the uterus when there are more liquids in the body that are being filtered by the kidneys. The uterus is the pipe that is connecting the kidneys with the bladder where the urine is stored when these stones enter the uterus they might cause a blockage for the fluids to flow which leads to immense pain in the side and lower abdomen, nausea, fever, chillness and also pain while urinating. Due to these factors getting an erection might become very difficult with kidney stones.

A recent study[1] on kidney stones and serum testosterone levels in 6633 males shows that people with kidney stones have significantly less serum testosterone levels compared with people who don’t have kidney stones. Due to low testosterone levels, this is one of the possible causes of low libido which might lead to Erectile Dysfunction.

Available Treatments for Kidney Stone Removal and their effect on Erectile Dysfunction

Below are the different types of treatments available for the removal of kidney stones.

Extracorporeal shock wave lithotripsy

This technique is used for the removal of small stones from the Kidney. Stones consisting of sizes less than 10 mm can be successfully treated with this technique. The stones having sizes between 10 mm and 20mm can be treated taking into account the stone position in the kidney and the stone composition. 

The treatment consists of an X-Ray to locate the stones in the Kidney. Once the stones are found shock waves are aimed at the Kidney from the machines through the skin without any cuts on the skin. These shock waves go through the skin and break the stone into small pieces and the stones will be passed into the ureter and then eliminated through urine. 

The possible side effects of the treatment are

1. Damage to the kidney tissue.
2. A Stent might be required for the blockage due to the accumulation of stones in the ureter.
3. In rare cases, bleeding can also occur in the Kidney.

Extracorporeal shock wave lithotripsy and Erectile Dysfunction

A study [2] examining the impact of Shockwave Lithotripsy on erectile dysfunction suggests that temporary erectile dysfunction is a potential side effect of the treatment. Nonetheless, following treatment with Shockwave Lithotripsy, erectile dysfunction is more prevalent and severe in elderly and obese patients.

Percutaneous nephrolithotripsy

This technique is used to remove the stones that are considered large i.e more than 2 cm in size. The treatment consists of ultrasound to locate the stone once the stone is found anesthesia is administered to make a small cut in the back. Then the surgeon places a thin tube into the cut and with the help of a laser or high-energy shock waves the stone is broken into small pieces and with the help of a vacuum these stones are suctioned up. Instead of a vacuum some surgeons might put a stent and the stones can be flushed out from the kidney.

The possible side effects of the treatment are

1. Damage to the surrounding parts of the kidney.
2. Infection.
3. Bleeding.

Percutaneous nephrolithotripsy and Erectile Dysfunction

There is no evidence to suggest that percutaneous nephrolithotripsy causes erectile dysfunction as the procedure is done through a small incision made on the skin which won’t let the stones pass into the ureter causing additional problems. Additionally, underlying medical conditions such as kidney diseases, diabetes, and cardiovascular diseases which may contribute to kidney stone formation require Percutaneous nephrolithotripsy for the removal of the stones can also increase the risk of erectile dysfunction.

Ureteroscopy

With the help of this technique, the stones can be removed from the kidney as well as the ureter. During this treatment, the surgeon will pass the thin tube through the urethra that goes through the bladder, ureter, and all the way to the kidney. Once the stones are located with the help of a laser the stones are broken into smaller particles and are drained into the bladder from the kidney through a stent which can be at the surgeon’s discretion. 

The possible side effects of Ureteroscopy are

1. Shrinking of the ureter.
2. Injury to the ureter.
3. Infection. 
4. Bleeding.

Ureteroscopy and Erectile Dysfunction

Ureteroscopy is a widely accepted treatment due to not having any cuts on the skin even to remove the bigger stones. Even though the equipment for ureteroscopy is getting advanced in terms of reduction of the size of the tube there are a few complications like stone mass getting coagulated and stone fragments which might cause a temporary blockage to the urinary tract which cause lower urinary tract symptoms which greatly increases the risk for erectile dysfunction.

The study[3] suggests that ureteroscopy may have a significant impact on erectile dysfunction, but further research is needed to make definitive conclusions on the matter.

Conclusion

In conclusion, the treatment of kidney stones involves several options, but all come with potential complications. The risk of developing erectile dysfunction is higher in treatments such as Extracorporeal shock wave lithotripsy and Ureteroscopy, where the broken particles pass through the ureter for elimination. On the other hand, Percutaneous nephrolithotripsy treatment appears to be a safer alternative, as it is a skin-based procedure with no known evidence of causing erectile dysfunction. However, more studies are needed to determine the procedure with the least risk of causing this condition. Patients should work closely with their healthcare providers to select the most appropriate treatment option while taking into account their specific medical conditions and potential risks.

References:

1. https://www.frontiersin.org/articles/10.3389/fendo.2022.863675/full#:~:text=Participants%20with%20kidney%20stones%20had,%3C0.001%2C%20Table%201
2. https://www.karger.com/Article/Abstract/517545
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757009/