Evaluating the Sexual Quality of Life of Kidney Stone Formers: A Multicentric Cross-Sectional Study

202 kidney stone patients surveyed: men with recurrent stones showed worse erectile function, women reported low arousal regardless of stone burden

Journal: Journal of Endourology | Published: 2026-01-23 | Type: Multicenter Cross-Sectional Study | PMID: 41810588 Authors: Bouhadana D et al. (McGill University Health Center, University of Toronto, University of Calgary, UC San Diego, University of Florida, University of British Columbia) Funding/COI: Funding source not disclosed. One author consults for Boston Scientific and Olympus.

Summary

The first study to examine sexual quality of life specifically in kidney stone patients recruited 202 adults across eight North American urology clinics. Overall, men reported good erectile and ejaculatory function, and both sexes reported high satisfaction and low sexual distress. The notable finding is a dose-response pattern: men with progressively more stone events reported progressively worse erectile function — though the cross-sectional design cannot establish whether stones cause erectile dysfunction or whether shared risk factors (obesity, metabolic syndrome, vascular disease) are driving both.

Claims

• Men averaged 12/15 on the MSHQ erectile subscale (good function) and 28/35 on the ejaculatory subscale
• Women scored 16/40 for sexual arousal, 14/30 for enjoyment, and 7/15 for orgasm — each in the low range
• Both men (28/35) and women (25/35) reported good overall sexual satisfaction; sexual distress was low for men (5/20) and women (6/20)
• Men with 2–5 stone events had significantly worse erectile function versus those with fewer events (β = 2.95, 95% CI [0.92–4.98], p = 0.005)
• Association held for 6–10 events (β = 2.64, CI [0.64–5.22], p = 0.045) and >10 events (β = 3.75, CI [0.80–6.70], p = 0.014)
• Men averaged 7 stone events (SD 13); women averaged 10 (SD 32)

Study Quality

Cross-sectional surveys cannot establish causation, and the authors don't try to hide that — they explicitly note the association "may not be causal." Four validated instruments were used throughout (Sexual Distress Scale, Global Measure of Sexual Satisfaction, Male Sexual Health Questionnaire, Sexual Function Questionnaire), which is appropriate for a first descriptive study in this population. The eight-center design reduces single-site selection bias.

The exclusion of patients on medications affecting erectile or ejaculatory function is a meaningful limitation. These are often the sickest patients — those managing diabetes, hypertension, or depression — and removing them inflates baseline function scores and likely underestimates dysfunction prevalence in the true stone-forming population. The sample skews male (70/30), and with only 60 women enrolled across eight centers over 21 months, the study is underpowered to detect predictors of female sexual dysfunction. The extremely wide standard deviations on stone event counts (men: SD 13 on a mean of 7; women: SD 32 on a mean of 10) indicate enormous variance that complicates clean interpretation of the regression groupings.

Red Flags

• Cross-sectional design rules out causal inference; authors concede this, yet still frame a secondary aim around identifying "patients who may benefit from sexual counseling"
• Funding source not disclosed — a basic transparency failure in a clinical study
• Exclusion of patients on ED or ejaculatory medications creates healthy survivor bias and almost certainly underestimates dysfunction rates
• 60 women total across eight sites over 21 months — too underpowered for meaningful female subgroup analysis
• Stone event SDs are so large (women: mean 10, SD 32) that the frequency groupings may not cleanly separate patient risk profiles
• One author consults for Boston Scientific and Olympus, both manufacturers of urological stone-treatment devices — modest but worth noting given the framing

Strengths

• First study to examine sexual QoL specifically in a kidney stone population — genuinely novel question
• Multicenter recruitment (eight North American sites) reduces single-institution bias
• Four validated, standardized questionnaires rather than ad hoc measures
• Prospective recruitment over a defined 21-month window
• Authors appropriately cautious about causal language in their conclusion

Verdict

A reasonable first pass at an overlooked question. The dose-response pattern between stone recurrence and erectile function is the headline number, and it's statistically consistent — but cross-sectional data can't tell you whether recurrent stones damage erectile function directly or whether the same metabolic profile that deposits kidney stones (obesity, insulin resistance, hypertension) is also quietly strangling penile vasculature. The female data is too thin to conclude much of anything. Undisclosed funding is sloppy for a multicenter clinical study. Read this as a hypothesis-generator: the next study needs a longitudinal design, larger female enrollment, and controls for metabolic comorbidities before the stone–ED link means anything actionable.