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Oner S, Onen E, Caglayan V, Avci S, Erdogan A, Kilic M, Topal S. The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males. Ann Med 2023; 55:2238185. [PMID: 37480584 PMCID: PMC10364566 DOI: 10.1080/07853890.2023.2238185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/08/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023] Open
Abstract
Objective: To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men.Methods: Elderly male patients who had undergone percutaneous nephrolithotomy were screened retrospectively and divided into 2 groups: percutaneous nephrolithotomy under combined spino-epidural anaesthesia (Group CSEA, n = 70) and percutaneous nephrolithotomy under general anaesthesia (Group GA, n = 114). Preoperative, perioperative and postoperative outcome measures were examined.Results: Between the two groups, there was no statistically significant difference in terms of stone burden, stone location, presence of the previous operation in the same kidney, presence of staghorn stones, mean American Society of Anesthesiologists scores and presence of abnormal kidney (p > 0.05). The mean duration time in the operation room and post-anaesthesia care unit (PACU) was statistically shorter in the Group CSEA (p < 0.01). There was no significant difference between the two groups in terms of Clavien Grade 1 and above complications (p > 0.05). Stone-free rates and success rates were similar in both groups (p = 0.133 and p = 0.273, respectively).Conclusion: The type of anaesthesia does not affect the success rate and complication rate of percutaneous nephrolithotomy in elderly male patients. Patients who underwent percutaneous nephrolithotomy under CSEA needed less analgesic injection during the postoperative period. CSEA can shorten the time a patient spends in the operating room and PACU, which provides more effective use of operation room working hours.
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Affiliation(s)
- Sedat Oner
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Efe Onen
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Volkan Caglayan
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Sinan Avci
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Abdullah Erdogan
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Metin Kilic
- Department of Urology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Serra Topal
- Department of Anesthesiology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
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Liu J, Gu J, Xu W, Tian C, Pang D, Zhang N, Liu Y, Yang B, Huang X. Efficacy and safety of percutaneous nephrolithotripsy in elderly patients: a retrospective study. BMC Surg 2022; 22:392. [DOI: 10.1186/s12893-022-01830-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Percutaneous nephrolithotripsy (PCNL) is difficult to perform for elderly patients; thus, this study aimed to assess its efficacy and safety in elderly patients aged > 70 years, note any associations between outcomes and patient characteristics, and summarize relevant themes and observations.
Methods
Data from patients older than 70 years who had undergone PCNL for upper urinary tract calculi between January 2016 and January 2021 was retrospectively analyzed. Risk factors for postoperative complications and residual stones were analyzed using multivariate logistic regression.
Results
A total of 116 elderly patients underwent 122 PCNL operations, of which six underwent secondary PCNL operations, and all of which were successfully completed. The average age was 74.6 ± 4.3 years; the average stone size and operation time were 3.5 ± 1.8 (1.2–11 cm), and 71.8 ± 34.1 min, respectively. Of the participants, 16 or 13.8% had postoperative complications and 29 (25%) had residual stones after operation. The stone free rate was 75%. Multivariate analysis revealed that an American Score of Anesthesiology III was an independent risk factor for postoperative complications (odds ratio [OR] = 4.453, p = 0.031), and staghorn calculi were independent risk factors for postoperative residual calculi (OR = 31.393, p = 0.001).
Conclusion
PCNL was shown to be safe and effective for elderly patients aged > 70 years. Further, ASA III was an independent risk factor for postoperative complications, and staghorn calculi were independent risk factors for postoperative residual calculi in elderly patients.
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Sahan M, Yarımoğlu S, Savun M, Erdemoglu O, Degirmenci T. The Influence of Aging on Outcomes in Patients Undergoing Percutaneous Nephrolithotomy for Complete Staghorn Stones: A Retrospective Comparative Study. Cureus 2021; 13:e20001. [PMID: 34984150 PMCID: PMC8715892 DOI: 10.7759/cureus.20001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/05/2022] Open
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Aro T, Mikula M, Benjamin TGR, Rai A, Smith A, Okeke Z, Hoenig DM. Utility of Frailty Assessment in Urologic Stone Surgery: A Review of the Literature. J Endourol 2021; 36:132-137. [PMID: 34238055 DOI: 10.1089/end.2021.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction & Objective As life expectancy continues to rise, the prevalence of frailty is also increasing. The idea of frailty and its effect on the operative patient has been previously studied, but not regularly incorporated into routine practice. We present a review on frailty metrics in the literature, validated assessment methods, and simplified screening tools, to better predict and optimize patient outcomes. Methods An online Pubmed search was conducted by 3 authors (TA, TB, MM) for all frailty, frailty assessment, and pre-operative risk assessment. Only English publications were included in the analysis. Full text analysis was then conducted by all three authors to validate the data. Results An abundance of literature was found on frailty. Even though some methods are validated as very effective for assessing frailty, they may be time consuming and require a specialist. various quick screening methods are also present, many already validated, and should be utilized by urologist more regularly. Conclusions Multiple studies demonstrate the relationship between frailty and surgical patients' outcome. Many quick, office based, validated tools to screen for frailty are described, and should be incorporated into our practice in appropriate patients. Future research is now focused on the concept of "prehabilitation" to improve patient frailty status in the pre-operative setting, and consequently operative outcomes.
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Affiliation(s)
- Tareq Aro
- Hofstra University North Shore LIJ School of Medicine, 232890, The Smith Institute for Urology, Hempstead, New York, United States;
| | - Mathew Mikula
- Hofstra University North Shore LIJ School of Medicine, 232890, The Smith Institute for Urology, Hempstead, New York, United States;
| | - Tavya G R Benjamin
- Hofstra University North Shore LIJ School of Medicine, 232890, The Smith Institute for Urology, Hempstead, New York, United States;
| | - Arun Rai
- Hofstra University North Shore LIJ School of Medicine, 232890, The Smith Institute for Urology, Hempstead, New York, United States;
| | - Arthur Smith
- Hofstra University North Shore LIJ School of Medicine, 232890, The Smith Institute for Urology, Hempstead, New York, United States;
| | - Zeph Okeke
- Hofstra University North Shore LIJ School of Medicine, 232890, Smith Institute for Urology, Hempstead, New York, United States;
| | - David M Hoenig
- Hofstra University North Shore LIJ School of Medicine, 232890, The Smith Institute for Urology, Hempstead, New York, United States;
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Haberal HB, Gudeloglu A, Deger M, Gulsen M, Izol V, Bostanci Y, Aridogan İA, Ozden E, Bilen CY. Percutaneous Nephrolithotomy in Young-Old, Old-Old, and Oldest-Old Patients: A Multicenter Study. J Laparoendosc Adv Surg Tech A 2021; 31:796-802. [DOI: 10.1089/lap.2020.0537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mutlu Deger
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Murat Gulsen
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Volkan Izol
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Yakup Bostanci
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | | | - Ender Ozden
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Yarimoglu S, Sahan M, Polat S, Koras O, Erdemoglu O, Degirmenci T. The comparison of perioperative outcomes between percutaneous nephrolithotomy and retrograde intrarenal surgery in elderly patients. Int J Clin Pract 2021; 75:e14221. [PMID: 33871135 DOI: 10.1111/ijcp.14221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES In this study, we aimed to compare the outcomes and complication rates of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in elderly patients. MATERIALS AND METHODS Between April 2011 and January 2020, patients who underwent PCNL and RIRS for renal stone in elderly patients were retrospectively evaluated. The two groups' perioperative values, stone-free rates and complication rates were compared. Post-operative complications were noted according to the Clavien scoring system. RESULTS There were 89 and 72 patients in the PCNL and RIRS group respectively. The median age was 67 years in both the groups (P = .192). The stone size were 22.2 ± 3.5 mm and 19.9 ± 7.1 mm in the PCNL and RIRS group, respectively (P = .082). Stone-free rates were significantly higher in PCNL group (P = .021, P = .034). Also we found that overall complication and major complication rates were significantly higher in PCNL group (P = .016, P = .029). CONCLUSION Despite there was higher stone clearance in PCNL, the complication rates were higher compared with RIRS. So RIRS might be a safe alternative treatment method to PCNL in older patients.
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Affiliation(s)
- Serkan Yarimoglu
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Murat Sahan
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Salih Polat
- Department of Urology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Omer Koras
- Department of Urology, Faculty of Medicine, Hatay University, Hatay, Turkey
| | - Onur Erdemoglu
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Besiroglu H, Merder E, Dedekarginoglu G. Percutaneous nephrolithotomy is safe and effective in aging male patients: a single center experience. Aging Male 2020; 23:705-710. [PMID: 30857456 DOI: 10.1080/13685538.2019.1581756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of percutaneous nephrolithotomy in aging male patients. METHODS Two hundred eighty-three male patients over the years of forty undergoing percutaneous nephrolithotomy between December 2009 and September 2014 were evaluated, retrospectively. The patients were stratified by four age groups [40-49 (group-1), 50-59 (group-2), 60-69 (group-3), ≥70 years (group-4)]. The groups were compared regarding stone size, mean operation time, mean access number, mean nephrostomy removal time, hospitalization duration, stone-free rate, and complications rate. The patients were also evaluated with regard to glomerular filtration rate levels preoperatively and in the sixth month after surgery. RESULTS Mean stone size was 810 ± 490 mm2 in group-1, 840 ± 500 mm2 in group-2, 845 ± 480 mm2 in group-3, and 800 ± 460 mm2 in group-4 (p = .02). There was no statistical difference between the four groups in terms of mean operation time, access number, hemorrhage, nephrostomy removal time, and hospital stay duration (p > .05). After additional interventions; no significant difference was detected for final stone-free rates among the groups (p = .12). A significant improvement was detected in glomerular filtration rate levels in the sixth month after surgery in all groups (p < .05). CONCLUSION These results indicate that percutaneous nephrolithotomy is a safe and effective method in aging male patients.
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Affiliation(s)
| | - Erkan Merder
- Urology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Galip Dedekarginoglu
- Urology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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Besiroglu H, Merder E, Dedekarginoglu G. The safety and effectiveness of percutaneous nephrolithotomy in solitary kidney aging male patients: our single-center experience. Aging Male 2020; 23:1134-1140. [PMID: 31900026 DOI: 10.1080/13685538.2019.1708316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of percutaneous nephrolithotomy (PCNL) in aging male patients with a solitary kidney. METHODS Among the patients undergoing PCNL between December 2009 and September 2014, 16 patients with solitary kidney (group 1) over the age of 40 were included in the analysis. Twenty patients with bilateral kidney patients (group 2) were included in the analysis, which constituted an age-matched control group. The patients' characteristics, stone characteristics, intraoperative and postoperative outcomes, including bleeding and transfusion rates, operative time, complications, hospital stay, stone-free rates (SFR) and renal function were evaluated. RESULTS Mean age of the patients in groups 1 and 2 were 63.7 (range 48-73) and 64.8 (range 48-77). Mean stone size was 814 ± 390 mm2 in group 1, and 820 ± 405 mm2 in group 2 with no statistical significance (p = .35). The final SFR in the solitary kidney and bilateral kidney group was 87.5 and 90% (p = .07). Bleeding requiring transfusion, prolonged leakage from nephrostomy tract, mean operation time and access number were comparable between two groups (p > .05). However, the nephrostomy removal and hospital stay time were longer in the solitary kidney group (p < .05). The rate of perioperative DJ insertion was also higher in solitary kidney patients. A significant improvement was detected in creatinine and glomerular filtration rate levels in the sixth months after surgery in solitary kidney patients (p < .05). CONCLUSION These results indicate that PCNL is a safe and effective method in aging male patients with a solitary kidney.
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Affiliation(s)
- Huseyin Besiroglu
- Department of Urology, Catalca Ilyas Cokay State Hospital, Istanbul, Turkey
| | - Erkan Merder
- Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Galip Dedekarginoglu
- Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Emiliani E, Piccirilli A, Cepeda-Delgado M, Kanashiro AK, Mantilla D, Amaya CA, Sanchez-Martin FM, Millan-Rodriguez F, Territo A, Amón-Sesmero JH, Palou-Redorta J, Angerri-Feu O. Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe. World J Urol 2020; 39:2703-2708. [PMID: 32960326 DOI: 10.1007/s00345-020-03448-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/05/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.
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Affiliation(s)
- E Emiliani
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain.
| | - A Piccirilli
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - M Cepeda-Delgado
- Department of Urology, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - A K Kanashiro
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - D Mantilla
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - C A Amaya
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - F M Sanchez-Martin
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - F Millan-Rodriguez
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - A Territo
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - J H Amón-Sesmero
- Department of Urology, Hospital Universitario Rio Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - J Palou-Redorta
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
| | - O Angerri-Feu
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Calle Cartagena 340, 08025, Barcelona, Spain
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Gupta R, Mahajan A. Outcomes of percutaneous nephrolithotomy in elderly versus young patients under regional anesthesia: A comparative study. Urol Ann 2020; 12:254-258. [PMID: 33100751 PMCID: PMC7546074 DOI: 10.4103/ua.ua_69_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/02/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Surgical management of elderly patients with renal calculi is inherently challenging. We compared the efficacy and safety of percutaneous nephrolithotomy (PCNL) performed under regional anesthesia between elderly patients (age >65 years) and patients aged <65 years. Materials and Methods Between July 2015 and June 2016, fifty patients aged >65 years with renal stones (size >1.5 cm) were treated with PCNL under regional anesthesia (elderly group). We retrospectively compared the outcomes with those obtained in an equal number of patients aged <65 years (younger group) who underwent PCNL under regional anesthesia. Patients with staghorn stones and pyonephrosis and falling under the American Society of Anesthesiologists (ASA) Grade IV were excluded. Data pertaining to demographic characteristics, body mass index, stone bulk, operative time, tract size, number of tracts required, blood loss, clearance rates, complications, and length of hospital stay were analyzed. Results The mean age at presentation in the elderly and younger groups was 66.8 ± 2.1 years and 38.7 ± 11 years, respectively; 56% of the patients in the elderly age group had ASA Grade II, whereas 58% in the younger age group had ASA Grade I. The mean stone size and the number of tracts were comparable in both the groups, whereas operative time was slightly longer in the elderly group (58.54 ± 18 vs. 51.98 ± 18 min; P < 0.05). Postoperative complications and stone-free rates (94% vs. 92%, respectively) were comparable in the two groups. Conclusions Age itself should not deter the treatment of elderly patients with renal stones as PCNL under regional anesthesia is safe and effective in elderly patients; outcomes in elderly and younger patients were comparable in this study.
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Affiliation(s)
- Rahul Gupta
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Arti Mahajan
- Department of Anesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
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Abedali ZA, Large T, Heiman JM, Bandali E, Anderson BB, Lingeman JE, Krambeck AE. Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population. Urology 2019; 134:62-65. [PMID: 31536740 DOI: 10.1016/j.urology.2019.08.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. METHODS From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. RESULTS Of the 1,647 patients, median age was 46, 66, and 83, respectively (P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. CONCLUSION PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.
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Affiliation(s)
- Zain A Abedali
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Tim Large
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Joshua M Heiman
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Elhaam Bandali
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Blake B Anderson
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - James E Lingeman
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN
| | - Amy E Krambeck
- Department of Urology, Indiana University/IU Health Physicians, Indianapolis, IN.
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Cakici MC, Sari S, Selmi V, Sandikci F, Karakoyunlu N, Ozok U. Is the Efficacy and Safety of Retrograde Flexible Ureteroscopy in the Elderly Population Different from Non-elderly Adults? Cureus 2019; 11:e4852. [PMID: 31410335 PMCID: PMC6684111 DOI: 10.7759/cureus.4852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives The population of elderly adults is increasing globally, and due to metabolic changes related to advanced age, many elderly adults experience kidney stones. Flexible ureteroscopy (f-URS) is a minimally invasive procedure to treat kidney stones, but it is not free of complications. The goals of this study were to analyze the efficacy and safety of f-URS in the management of kidney stones in patients aged ≥60 years and compare the outcomes of this surgery with the outcomes of the same surgery in a younger population. Materials and methods We retrospectively reviewed patient data from 1750 patients who met our inclusion criteria and received f-URS at the urology clinic of our hospital from 2012 to 2017. Patients were assigned into two groups: those aged ≥60 years (Group 1, n=291) and those aged 19-59 years (Group 2, n=1459). The perioperative results were evaluated comparatively. We performed multivariable analyses for factors predicting complications. Results When we compared the groups on demographic attributes, we noted statistically significant differences in gender, body mass index (BMI), and American Society of Anesthesiologists scores. Stone size and operation time were higher in the ≥60-year age group (Group 1). Other stone characteristics and operative features were similar. Stone-free rates (SFR) after the first procedure were 88.0% in Group 1 and 89.2% in Group 2. SFR and success rates at three months were similar for both groups. The complication rates were similar, and multivariable regression analysis revealed the most important factor affecting the complications was the presence of residual stones in both groups. The second most important factor affecting the complication was the operation time in Group 1 and the number of stones in Group 2. Conclusion In our study, there were no significant differences in terms of results and complications among elderly and young patients after f-URS except for the duration of the operation. The prolongation of operation time results in worse outcomes in terms of perioperative complications in patients aged ≥60 years. f-URS is a relatively safe and efficient procedure, with a small risk of minor complications even in the elderly population, with increased comorbidity.
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Affiliation(s)
- Mehmet Caglar Cakici
- Urology, Medeniyet University, Göztepe Training and Research Hospital, Istanbul, TUR
| | - Sercan Sari
- Urology, Bozok University Faculty of Medicine, Yozgat, TUR
| | - Volkan Selmi
- Urology, Bozok University Faculty of Medicine, Yozgat, TUR
| | - Fatih Sandikci
- Urology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Nihat Karakoyunlu
- Urology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Ugur Ozok
- Urology, Karabuk University School of Medicine, Karabük, TUR
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Tseng JS, Lin WR, Sun FJ, Lin TF, Tsai WK, Chiang PK, Lee CC, Chen YH, Chiu AW, Chen M. Predicting Percutaneous Nephrolithotomy Outcomes and Complications in Elderly Patients Using Guy's Scoring System and Charlson Comorbidity Index. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ozgor F, Yanaral F, Savun M, Ozdemir H, Caglar U, Sarilar O. Comparison of miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy for moderate size renal stones in elderly patients. Kaohsiung J Med Sci 2018; 34:352-356. [DOI: 10.1016/j.kjms.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/29/2017] [Accepted: 10/11/2017] [Indexed: 11/16/2022] Open
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Kumar S, Keshavamurthy R, Karthikeyan VS, Mallya A. Complications after prone PCNL in pediatric, adult and geriatric patients - a single center experience over 7 years. Int Braz J Urol 2017; 43:704-712. [PMID: 28783266 PMCID: PMC5557447 DOI: 10.1590/s1677-5538.ibju.2016.0563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/26/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction CROES-Clavien system (CCS) for grading complications in percutaneous nephrolithotomy (PCNL) is a step towards standardization of outcomes. We categorized complications based on CCS and predicted risk factors across the entire cohort and individually for pediatric (P: ≤18 years), adult (A: 19-65 years) and geriatric (G: ≥65 years) subgroups to assess the risk factors in each subset. We assessed association of complications with length of hospitalization (LOH) and operation time (OT). Materials and Methods Retrospective record review of unilateral PCNL performed between January 2009-September 2015 at a tertiary care center in India, performing around 150 PCNL per year. Results Out of 922 (P=61; A=794; G=67) PCNL, 259 (28.09%) complications occurred with CCS I, II, III and IV constituting 152 (16.49%), 72 (7.81%), 31 (3.36%) and 4 (0.43%) respectively and its distribution was similar across the subsets and majority (224; 24.3%) were minor (CCS-1, 2). Placement of a nephrostomy (47.4%; 18/38) in Group P, supracostal access, ≥2 punctures, higher GSS, nephrostomy, staghorn stones, ≥2 stones, stone size in Group A and hydronephrosis and prolonged OT in Group G were significantly associated with complications. On logistic regression, need of nephrostomy (adj. OR - 4.549), OT (adj. OR - 1.364) and supracostal access (adj. OR - 1.471) significantly contributed to complications in the study population. LOH was found to be significantly associated with complications (p<0.001). Conclusions Contrary to the belief that extremes of ages are associated with complications of prone PCNL, we found age does not alter the incidence or grade of complications and LOH.
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Affiliation(s)
- Sumit Kumar
- Department of Urology, Institute of Nephrourology, Bangalore, India
| | | | | | - Ashwin Mallya
- Department of Urology, Institute of Nephrourology, Bangalore, India
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Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D, Dalpiaz O, Cracco C, Scoffone C, Giusti G, Cindolo L, Schips L. RIRS in the elderly: Is it feasible and safe? Int J Surg 2017; 42:147-151. [PMID: 28476544 DOI: 10.1016/j.ijsu.2017.04.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this study was to compare the safety and efficacy of RIRS in men ≥65 years to those <65 years. MATERIALS AND METHODS Patients who underwent RIRS were prospectively collected from March 2013 to March 2014 in 5 European centers. Perioperative outcomes and complications in elderly men were compared with men <65 years. Univariable and multivariable analyses were performed for factors predicting overall complications. The groups were compared using Mann-Whitney U test. Categorical variables were compared using chi-squared test and the Yates correction or the Fisher's exact test. RESULTS A total of 399 patients with renal stones were included, 308 (77.19%) were aged <65 years, 91 (22.8%) were aged ≥65 years. Elderly patients were more likely to have higher ASA scores (35.7% vs 92.3%; p < 001), Charlson Comorbidity Index (1.8 vs. 5.2, p < 0.001), hyperlipidemia (10.06% vs. 30.76%; p = 0,0005) and coronary heart disease (5.51% vs. 17.58; p = 0.005) compared to younger cohort. Perioperative outcomes (stone free rate, operative time and re-intervention rate) did not show differences between the two groups (p > 0.05). Surgical and medical complication rates were similar between the cohorts (14.28% vs 9.89%; p = 0.38). Multivariate analysis did not identify any predictive factors of complications among the two groups (p > 0.05). CONCLUSIONS In this study, elderly RIRS patients had comparable short term efficacy and perioperative complications to younger patients, despite a higher prevalence of comorbidity. Age itself should not be considered as a risk factor for the development of complications in patients undergoing RIRS for renal stone.
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Affiliation(s)
- F Berardinelli
- Department of Urology, "S. Pio da Pietrelcina'' Hospital, Vasto, CH, Italy.
| | - P De Francesco
- Department of Urology, "S. Pio da Pietrelcina'' Hospital, Vasto, CH, Italy
| | - M Marchioni
- Department of Urology, "S. Pio da Pietrelcina'' Hospital, Vasto, CH, Italy
| | - N Cera
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - S Proietti
- Urology Dept, Urological Research Institute, IRCCS Ospedale San Raffaele, Ville Turro Division, Milan, Italy
| | - D Hennessey
- Department of Urology, Austin Health, Melbourne, Australia
| | - O Dalpiaz
- Urologische Klinik, Medizinische Universität, Graz, Austria
| | - C Cracco
- Urologia, Ospedale Cottolengo, Torino, Italy
| | - C Scoffone
- Urologia, Ospedale Cottolengo, Torino, Italy
| | - G Giusti
- Urology Dept, Urological Research Institute, IRCCS Ospedale San Raffaele, Ville Turro Division, Milan, Italy
| | - L Cindolo
- Department of Urology, "S. Pio da Pietrelcina'' Hospital, Vasto, CH, Italy
| | - L Schips
- Department of Urology, "S. Pio da Pietrelcina'' Hospital, Vasto, CH, Italy
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Néphrolithotomie percutanée des calculs rénaux des personnes âgées : méta-analyse des résultats et complications. Prog Urol 2017; 27:58-67. [DOI: 10.1016/j.purol.2016.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/12/2016] [Accepted: 12/17/2016] [Indexed: 11/21/2022]
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Reddy SVK, Shaik AB. Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi. Int Braz J Urol 2016; 42:262-9. [PMID: 27256180 PMCID: PMC4871386 DOI: 10.1590/s1677-5538.ibju.2014.0619] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/28/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. MATERIALS AND METHODS The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. RESULTS There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. CONCLUSION Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.
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Affiliation(s)
- S V Krishna Reddy
- Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Ahammad Basha Shaik
- Department of Statistics, Sri Venkateswara University, Tirupati, Andhra Pradesh, India
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Comparison of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of intermediate proximal ureteral and renal stones in the elderly. Urolithiasis 2015; 44:427-34. [PMID: 26705003 DOI: 10.1007/s00240-015-0854-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/07/2015] [Indexed: 12/16/2022]
Abstract
The aim of this study is to compare the outcomes of flexible ureteroscopy (fURS) and minimally invasive percutaneous nephrolithotomy (mPNL) for the treatment of renal and/or proximal ureteral stones sized 1-2 cm in the elderly (≥60 years). Between January 2010 and March 2015, 184 consecutive mPNL and fURS were performed to treat intermediate renal and/or proximal ureteral stones in geriatric patients. The records were retrospectively reviewed and outcomes were compared. Although no significant difference was found in the complication rate between two groups, a statistical trend (p = 0.059) in favor of fURS was observed. In addition, multivariate analysis demonstrated that mPNL, preoperative positive urine culture and lower hemoglobin were independent risk factors for postoperative complication (p = 0.016, p = 0.021, p = 0.001, respectively). And fURS was significantly associated with less hemoglobin drop, red blood cell transfusion, analgesics requirement, postoperative hospital duration, and charges of laboratory tests, medical examinations and medications (p = 0.019, p = 0.037, p = 0.006, p = 0.000 and p = 0.007, p = 0.000, p = 0.000, p = 0.001, respectively), while higher costs of operations (p = 0.008). Receiver operating characteristic curve suggested a preoperative hemoglobin of 106.5 g/L as the threshold for predicting red blood cell transfusion after mPNL. The overall one-session stone-free rate of fURS at 1 month was lower (p = 0.006), while it was similar for solitary stone between two groups. Comorbidity and previous stone surgery did not affect postoperative complication and stone-free rate. This study shows that mPNL is more effective for multiple stones, but fURS is associated with potentially less complications and postoperative hospital stay. Furthermore, preoperative hemoglobin level and urine culture can be used to predict postoperative complication risk and they may be helpful in choosing treatment methods for the elderly.
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Ozturk H. Tubeless versus standard PCNL in geriatric population. Actas Urol Esp 2015; 39:494-501. [PMID: 25937149 DOI: 10.1016/j.acuro.2015.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for large-volume renal calculi for all age groups. Nephrostomy tube constitutes an invaluable part of the nephrolithotomy operation. However, the nephrostomy tube has been recently replaced with ureteral catheter or double J-stent thanks to advances in urotechnology and operation equipment. The aim of the current article was to evaluate the safety and reliability of tubeless percutaneous nephrolithotomy in the geriatric population. METHODS Between January 2009 and September 2013, a total of 52 patients aged 65 years or elder with renal calculi bigger than 2cm underwent PCNL operation. The first group of 25 patients (48%) with a mean age of 70.0 years (std:±3,8) underwent tubeless PCNL whereas the second group consisting of 27 (52%) patients with a mean age of 71.3 years (std: ±4,0) underwent standard PCNL. The patients were randomly compared retrospectively in terms of burden of calculus, analgesic requirement, creatinine value, renal parenchymal thickness, Body-mass index (BMI), clavien score, length of hospitalization, and being calculus-free. RESULTS The groups were found to be similar in age, BMI, and gender (P>.05). Burden of calculus, duration of operation, and rate of narcotic analgesic use were found to be statistically significantly higher in the group of Standard PCNL group than in the Tubeless PCNL group (P<.05). Length of hospital stay was 1.7 days in the group of tubeless PCNL and 2.6 days in the standard PCNL group (P<.05). No significant difference was found between the groups in terms of fall in hemoglobin, creatinine, values of parenchymal thickness, and clavien score, preoperative blood transfusion, previous SWL, location of calculi, number of access, and rate of success (P>.05). Burden of calculus was 900 mm2 (304-4232) in the standard PCNL group and 600mm(2) (220-2660) in the tubeless PCNL group with the difference being statistically significant (P=.014). Overall success was achieved in 96.0 and 96.3% of tubeless PCNL and standard PCNL patients after one session of PCNL, respectively. CONCLUSIONS Tubeless percutaneous nephrolithotomy was found to be as safe and effective as standard PCNL in the geriatric population. It is recommended especially in this group of patients because of its advantages such as shorter length of hospitalization, less analgesic requirement, and earlier mobilization.
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Affiliation(s)
- H Ozturk
- Department of Urology, School of Medicine, Sifa University, Izmir, Turquía.
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Morganstern B, Galli R, Motamedinia P, Leavitt D, Keheila M, Ghiraldi E, Hoenig D, Smith A, Okeke Z. Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? Asian J Urol 2015; 2:208-213. [PMID: 29264147 PMCID: PMC5730742 DOI: 10.1016/j.ajur.2015.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To specifically report perioperative characteristics and outcomes in patients 80 years and older undergoing percutaneous nephrolithotomy (PCNL). PCNL has been established as feasible in the elderly; however, to our knowledge no one has specifically reported feasibility in patients 80 years and older. Methods We retrospectively reviewed perioperative data of octogenarians who underwent PCNL at a high stone volume single institution, and matched them to patients <65 years of age by stone burden and sex. Patient demographics, perioperative outcomes and postoperative complications were compared. Results Thirty-three octogenarians (mean age 83.6 years) with 36 renal units were matched to 67 controls (mean age 48.6 years) with 72 renal units. Octogenarians had a higher mean American Society of Anesthesiologists (ASA) score, more comorbidities, and worse renal function. There were no differences in operative characteristics, length of hospital stay or stone free rates. Of the patients with preoperative urinary decompression (ureteral stent or nephrostomy tube) prior to PCNL, the elderly were more likely to have a history of urosepsis. Octogenarians did not experience more minor Clavien (I – II) or major Clavien (IIIa – IVb) complications. Conclusion Octogenarians who undergo PCNL were more likely to have cardiovascular comorbidities and a prior history of sepsis. Despite these risk factors, in appropriately selected patients PCNL can be safely and successfully performed in octogenarians without increased perioperative complications relative to a younger cohort.
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Affiliation(s)
- Bradley Morganstern
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Riccardo Galli
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Piruz Motamedinia
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - David Leavitt
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Mohamed Keheila
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Eric Ghiraldi
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - David Hoenig
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Arthur Smith
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Zeph Okeke
- The Smith Institute for Urology, NorthShore-Long Island Jewish Health System, New Hyde Park, NY, USA
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Safety and efficacy of retrograde intrarenal surgery in patients of different age groups. Actas Urol Esp 2015; 39:354-9. [PMID: 25667174 DOI: 10.1016/j.acuro.2014.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. PATIENTS AND METHODS We performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analysed both as a continuous and categorical variable and patients were categorized into three age groups; aged ≤ 15 years at surgery (group i, n=51), 16 - 60 years (group Ii, n=726) and>60 years (group iii, n=170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. RESULTS The stone-free rate was 78.4% in group i, 77.5% in group ii, and 81.1% in group iii (P=.587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group i, 5.6% group ii, and 7.6% in group iii. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group ii and 2 patients (1.1%) in group iii. A 48-year-old man died from septic shock 5 days after the surgery. CONCLUSIONS RIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor.
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Buldu I, Tepeler A, Karatag T, Bodakci MN, Hatipoglu NK, Penbegul N, Akman T, Istanbulluoglu O, Armagan A. Does aging affect the outcome of percutaneous nephrolithotomy? Urolithiasis 2014; 43:183-7. [PMID: 25395249 DOI: 10.1007/s00240-014-0742-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
To investigate whether aging affects surgical outcomes by comparing the results of two patient groups undergoing PNL: those over 60 and those under 60. A retrospective screen was made for patients undergoing conventional PNL surgery for renal stones performed in two separate centers between 2010 and 2013. 520 patients included were classified into age groups: patients aged 18-59 comprised Group-1 and those aged over 60 comprised Group-2. Those between 60-69 years (sexagenarian) were assigned to Group-2a; 70-79 years (septuagenarian) to Group-2b; and 80-89 years (octogenarian) to Group-2c. Patients' demographic characteristics (accompanying comorbidities, ASA scores, body mass indices and stone size) and perioperative values (duration of surgery and hospital stay, success and complication rates) were compared between the groups. Mean stone size was similar in groups (30.1 ± 15.5 vs. 31.5 ± 15.4 mm, p = 0.379). The mean ASA value for the patients in Group-1 was 1.61; significantly lower than that in the other groups (p = 0.000). The level of accompanying comorbidities in Group-1 was significantly lower than that of the other groups (p = 0.000). The mean duration of surgery, postoperative hematocrit drop, complication and success rate were statistically similar in Groups 1 and 2 (p = 0.860, p = 0.430, p = 0.7, and p = 0.66, respectively). The duration of hospital stay was significantly shorter in the patients in Group-1 compared to those in Group-2 (p = 0.008). In experienced hands, PNL can be safely and reliably performed in the treatment of renal stones in elderly patients.
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Affiliation(s)
- Ibrahım Buldu
- Department of Urology, School of Medicine, University of Mevlana, Konya, Turkey,
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Factors Influencing the Duration of Urine Leakage following Percutaneous Nephrolithotomy. Adv Urol 2014; 2014:105709. [PMID: 24648837 PMCID: PMC3932287 DOI: 10.1155/2014/105709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/05/2013] [Accepted: 12/26/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. The duration of urine leakage following the removal of the nephrostomy tube after percutaneous nephrolithotomy (PCNL) shows significant variations depending on the techniques used. We aimed to assess the factors likely to influence the duration of urine leakage. Material and Methods. In total, 103 patients who underwent PCNL were reviewed retrospectively. DUL was evaluated regarding patient characteristics, thickness of the access line, presence of hydronephrosis, and residual stones. Results. DUL was significantly prolonged in accordance with a decrease in the thickness of parenchyma tissue (R = −0.716, P < 0.001). DUL was prolonged as the degree of hydronephrosis (R = 0.526, P < 0.001) and the number of patients with residual stones (R = 0.273, P = 0.005) increased. Median DUL was significantly longer in patients with residual stones than those without residual stones (P = 0.002). In the receiving operating curve analysis, the optimum cut-off value of parenchymal thickness for hospitalization ≤12 h was 17.2 mm (sensitivity, 90.2%; specificity, 69.4%; P = 0.001). Conclusions. We found that parenchymal thickness of the access line, hydronephrosis, and residual stones were the most influential factors determining DUL following PCNL, respectively.
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Nakamon T, Kitirattrakarn P, Lojanapiwat B. Outcomes of percutaneous nephrolithotomy: Comparison of elderly and younger patients. Int Braz J Urol 2013; 39:692-700; discussion 701. [DOI: 10.1590/s1677-5538.ibju.2013.05.12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022] Open
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Nouralizadeh A, Lashay A, Ziaee SAM, Ahanian A, Sharifi SHH, Nikkar MM, Ojand A, Soltani MH. Percutaneous nephrolithotomy in high-risk patients: a single-center experience with more than 350 cases. Urol Int 2013; 90:394-8. [PMID: 23594973 DOI: 10.1159/000347032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the surgical outcomes and peri- and postoperative complications following percutaneous nephrolithotomy (PCNL) in high- and low-risk patients according to the American Society of Anesthesiologists (ASA) score. MATERIALS AND METHODS We reviewed the patient records of 2,281 cases older than 18 years who had undergone PCNL in the 3 previous years. The patients were divided into two groups: a low-risk group (ASA score 1, 2: 1,922 cases) and a high-risk group (ASA score 3, 4: 359 cases). RESULTS Analysis of the location and size of the stone, number and type of access, surgical approach, post-PCNL serum hemoglobin and decrease in glomerular filtration rate revealed no significant difference between the two groups. The stone-free rate was similar in both groups and the hospital stay in the high-risk patients was significantly greater than in the low-risk cases. 95% of low-risk and 91% of high-risk cases had surgical complications compatible with grade ≤II (Clavien system) and overall distribution of different grades of surgical complications was similar between the two groups (p = 0.177). CONCLUSION Success rate and surgical complications of PCNL in high-risk patients were comparable to low-risk patients. It seems that PCNL may be a safe and effective procedure even in high-risk patients.
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Affiliation(s)
- Akbar Nouralizadeh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Alyami F, Norman RW. Is an overnight stay after percutaneous nephrolithotomy safe? Arab J Urol 2012; 10:367-71. [PMID: 26558051 PMCID: PMC4442911 DOI: 10.1016/j.aju.2012.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 07/15/2012] [Accepted: 07/24/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To establish a clinical care pathway that plans for hospital discharge the day after percutaneous nephrolithotomy (PCNL), to evaluate the safety, effectiveness and feasibility of this pathway, and to identify factors associated with a postoperative length of hospital stay (LOS) of >1 day. PCNL is the treatment of choice for patients with large kidney stones and those in whom extracorporeal shockwave lithotripsy has failed, and the mean LOS is typically 2-5 days. PATIENTS AND METHODS We retrospectively reviewed the charts of 109 patients (mean age 57.4 years; 58 men, 53%) who had PCNL between 2006 and 2009. All had nephrostomy tubes placed after surgery. The patients' demographics, LOS, incidence of complications, clinical outcomes, stone-free rates, number of early postoperative emergency-room visits, need for subsequent admission and/or other procedures, were noted and analysed. The modified Clavien classification was used to describe the postoperative complications. Bivariate analyses were used to test for associations between LOS and other variables. RESULTS The mean (range) stone size was 2.2 (0.9-5.9) cm, and the mean (SEM) LOS was 1.7 (0.13) days. Of the 109 patients, 20% had a LOS of >1 day for surgical, 3% for medical and 5% for social reasons. The stone-free rate was 89%. There was no difference in the number of subsequent hospital visits or ancillary procedures for patients discharged after one or more postoperative nights. No variables were associated with a longer LOS. CONCLUSIONS An overnight hospital stay after PCNL is safe and represents an effective strategy for improved bed use in selected patients. A longer LOS was not affected by patient age or body mass index, stone size or operative time. We continue to use our clinical care pathway, as supported by these data.
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Affiliation(s)
| | - Richard W. Norman
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
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Unsal A, Resorlu B, Atmaca AF, Diri A, Goktug HNG, Can CE, Gok B, Tuygun C, Germiyonoglu C. Prediction of morbidity and mortality after percutaneous nephrolithotomy by using the Charlson Comorbidity Index. Urology 2012; 79:55-60. [PMID: 21855965 DOI: 10.1016/j.urology.2011.06.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/17/2011] [Accepted: 06/24/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To determine whether the Charlson Comorbidity Index (CCI) predicts postoperative medical complications and death in patients treated with percutaneous nephrolithotomy (PCNL). METHODS A total of 1406 PCNL procedures were performed at 4-stone referral centers between September 2004 and March 2011 were reviewed in this multicenter study. Variables included patient and stone characteristics, preoperative comorbidities, intraoperative data, and postoperative complications, including mortality. RESULTS The present study included 868 (61.7%) men and 538 (38.3%) women. Mean patient age was 44.1 years (range 1-81). CCI score was calculated as "0" for 993 patients (70.6%, called group I), "1" for 316 patients (22.5%, called group II) and"≥2" for 97 patients (6.9%, called group III). The incidence of comorbidities increased with age (P=.001). The overall postoperative complication rate was 29.3%. Life-threatening medical complications developed in 2.9% of patients in group I, 7.6% of patients in group II, and 21.6% of patients in group III, (P=.001). There were 3 deaths for an overall 0.2% mortality rate. Perioperative bleeding requiring blood transfusion was observed in 9.5% of patients, and we found an increased risk of hemorrhage associated with CCI score (P=.049). High CCI score, patient age, hemorrhage, and operative time were significantly related to higher medical complication rates after PCNL. CONCLUSIONS CCI is a quick, simple, and reproducible scoring system that accurately predicts the morbidity and mortality of PCNL.
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Affiliation(s)
- Ali Unsal
- Kecioren Training and Research Hospital, Department of Urology, and Hacettepe University, Faculty of Science, Department of Statistics, Ankara, Turkey
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Can we avoid percutaneous nephrolithotomy in high-risk elderly patients using the Charlson comorbidity index? Urology 2011; 79:1042-7. [PMID: 22196410 DOI: 10.1016/j.urology.2011.10.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether Charlson comorbidity index (CCI) predicts the postoperative complications after percutaneous nephrolithotomy (PCNL) and could be a plausible option to avoid surgery and its potential risks in elderly patients with significant comorbidites. METHODS The data from 283 elderly patients (age ≥ 60 years) who underwent PCNL in 4 large referral hospitals were reviewed in the present multicenter study. For each patient, we evaluated pre-existing comorbidities and calculated the CCI score. The patients were classified to 3 CCI score categories (0, 1, ≥ 2) and compared regarding the stone-free and complications rates. RESULTS The mean patient age was 64.7, 65.6, and 67.7 years in the 3 groups. The stone-free rate after primary PCNL was 85.7% in group 1, 86.1% in group 2, and 75.0% in group 3. These rates increased to 90.8%, 95.4%, and 83.9% after a second intervention (P = .049). The overall postoperative complication rate was 38.8%. The most common complication was hemorrhage necessitating blood transfusion in 34 patients (12%), and we found an increased risk of hemorrhage associated with the CCI score (P = .011). Life-threatening medical complications developed in 7.6% of the patients in group 1, 12% of the patients in group 2, and 28.6% of the patients in group 3 (P = .001). A multivariate logistic regression analysis showed that a high CCI score, bleeding, and operative time had significant influence on the postoperative medical complication in this population. CONCLUSION Conservative management of asymptomatic large kidney stones appears to be a safe alternative to PCNL in elderly patients with significant comorbidites.
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Long-term outcomes of percutaneous nephrolithotomy in 177 patients with chronic kidney disease: a single center experience. J Urol 2011; 187:173-7. [PMID: 22099999 DOI: 10.1016/j.juro.2011.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Indexed: 02/08/2023]
Abstract
PURPOSE We evaluated the long-term outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease. MATERIALS AND METHODS Data on 1,904 patients who underwent percutaneous nephrolithotomy between 2002 and 2011 were retrospectively collected. The estimated glomerular filtration rate for each patient was retrospectively calculated using a 4-variable modification of diet in renal disease equation. Patients were staged for chronic kidney disease by National Kidney Foundation guidelines. RESULTS A total of 242 patients (12.7%) had a preoperative glomerular filtration rate of less than 60 ml per minute/1.73 m(2). Those monitored a minimum of 1 year were included in analysis. The study included 177 patients with a mean ± SD age of 54.3 ± 12.1 years. Perioperative and postoperative complications were noted in 15.2% of patients. At a mean followup of 43.4 ± 22.7 months renal function in 29.4% of patients had improved but it remained the same or deteriorated in 54.2% and 16.4%, respectively. On multivariate regression analysis diabetes and preoperative or postoperative complications predicted renal function. The stone-free rate 3 months postoperatively was 80.2% (142 of 177 cases). Stones recurred during long-term followup in 36 of these patients (25.3%). Spontaneous stone passage was detected in 12 of the 35 patients (34.2%) with residual stones but 8 (22.8%) with residual stones experienced an increase in stone size. CONCLUSIONS At long-term followup renal function was maintained or improved in greater than 80% of patients with chronic kidney disease who underwent percutaneous nephrolithotomy. Stones recurred or residual stones grew in approximately 25% of these patients.
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Kuzgunbay B, Turunc T, Yaycioglu O, Kayis AA, Gul U, Egilmez T, Aygun C, Ozkardes H. Percutaneous nephrolithotomy for staghorn kidney stones in elderly patients. Int Urol Nephrol 2010; 43:639-43. [DOI: 10.1007/s11255-010-9885-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 12/06/2010] [Indexed: 11/29/2022]
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Complete supine percutaneous nephrolithotomy (csPCNL) in patients with and without a history of stone surgery: safety and effectiveness of csPCNL. ACTA ACUST UNITED AC 2010; 39:295-301. [DOI: 10.1007/s00240-010-0341-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 11/02/2010] [Indexed: 11/26/2022]
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Simunovic D, Sudarevic B, Galic J. Extracorporeal Shockwave Lithotripsy in Elderly: Impact of Age and Comorbidity on Stone-Free Rate and Complications. J Endourol 2010; 24:1831-7. [PMID: 20919916 DOI: 10.1089/end.2009.0329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dalibor Simunovic
- Department of Urology, University Hospital Osijek, The Reference Center for Urolythiasis of Croatian Ministry of Health, Osijek, Croatia
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Akman T, Binbay M, Yuruk E, Sari E, Seyrek M, Kaba M, Berberoglu Y, Muslumanoglu AY. Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: results of univariable and multivariable models. Urology 2010; 77:299-304. [PMID: 20970842 DOI: 10.1016/j.urology.2010.06.060] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/20/2010] [Accepted: 06/15/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the effects of kidney stones and patient-related parameters on the length of hospitalization (LOH), which is one important factor affecting the cost effectiveness of percutaneous nephrolithotomy (PCNL). Recently, increases in healthcare costs have highlighted the importance of evaluating the cost effectiveness of a treatment as much as its efficacy. MATERIAL AND METHOD During an 8-year period, the records of 1669 patients with renal calculi who underwent PCNL were reviewed retrospectively. Eleven patients with urosepsis were excluded from the present study. A total of 1658 patients were categorized into 2 groups (group 1 = ≤2 days; group 2 = >2 days) according to the median LOH (median = 2 days). Multivariate binary logistic regression analysis was used to detect the effects of independent variables, including the patient age, gender, body mass index, history of extracorporeal shock wave lithotripsy or open surgery, stone size and opacity, presence of hydronephrosis, and localization and number of accesses, on the LOH after PNL. RESULTS Overall success was achieved in 86.2% of cases after one session of PCNL. The mean length of hospitalization was 2.89 ± 1.66 days (range, 1-21). According to the outcome of the multivariate analysis, diabetes (P = .0001, OR = 1.67), impaired kidney function (P = .03, OR = 1.64), stone size (P = .031, OR = 1.31), number of accesses (P = .001, OR = 1.59), intercostal access (P = .001, OR = 1.79), and tubeless procedure (P = .0001, OR = 0.23) were variables influencing LOH. CONCLUSIONS The presence of diabetes, a large stone burden, intercostals access, multiple accesses, and impaired kidney function prolong the LOH after PCNL. The use of the tubeless procedure was able to diminish the LOH.
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Affiliation(s)
- Tolga Akman
- Haseki Training and Research Hospital, Department of Urology, Istanbul, Turkey.
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Kara C. Reply. Urology 2010. [DOI: 10.1016/j.urology.2009.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kara C, Resorlu B, Bayindir M, Unsal A. A Randomized Comparison of Totally Tubeless and Standard Percutaneous Nephrolithotomy in Elderly Patients. Urology 2010; 76:289-93. [PMID: 20299077 DOI: 10.1016/j.urology.2009.11.077] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 10/15/2009] [Accepted: 11/21/2009] [Indexed: 10/19/2022]
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Predictors of Cost and Clinical Outcomes of Percutaneous Nephrostolithotomy. J Urol 2009; 182:586-90. [DOI: 10.1016/j.juro.2009.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Indexed: 11/19/2022]
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Anagnostou T, Thompson T, Ng CF, Moussa S, Smith G, Tolley DA. Safety and outcome of percutaneous nephrolithotomy in the elderly: retrospective comparison to a younger patient group. J Endourol 2008; 22:2139-45. [PMID: 18811570 DOI: 10.1089/end.2007.0432] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To evaluate whether the overall safety and efficacy profile of percutaneous surgery for urinary stone disease in older (>70 years) patients might influence the decision for the procedure in the elderly. MATERIALS AND METHODS A large database was created from our patients (n = 1058) who underwent percutaneous surgery for stone disease between 1991 and 2003 in the Scottish Lithotriptor Centre, including clinical and operation details for each case. Only percutaneous nephrolithotomy cases with full details were studied (n = 779) and were grouped into two age groups: (1) between 17 and 69 years and (2) over 70 years. Statistical analysis evaluated differences in terms of operation-related adverse events, stone-free success rates, and clinical success rates (including stone-free cases and cases with residual fragments <4 mm). Further analysis was performed for the same endpoints after stratification of the patients by (1) previous stone procedures and (2) special clinical features. RESULTS In the overall database, no statistically important differences were found between the two groups in terms of stone burden before surgery, adverse events rates, complete stone-free rates, and clinical success rates. However, a statistical trend toward higher clinical success rates in favor of the younger group was seen (P = 0.051). Stratification of our database according to previous stone disease procedures or special clinical or anatomic characteristics has only shown a statistically important difference for clinical success rates in favor of the older group without special features (P = 0.01). CONCLUSION In experienced hands, age-related morbidity or age itself should not be a discouraging consideration when deciding on performing percutaneous nephrolithotomy, as the procedure is as equally feasible and safe in the elderly as in the younger patient population.
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Affiliation(s)
- Theodore Anagnostou
- The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom.
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Tok A, Ozturk S, Tepeler A, Tefekli AH, Kazancioglu R, Muslumanoglu AY. The effects of percutaneous nephrolithotomy on renal function in geriatric patients in the early postoperative period. Int Urol Nephrol 2008; 41:219-23. [PMID: 18953665 DOI: 10.1007/s11255-008-9482-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 09/22/2008] [Indexed: 11/30/2022]
Abstract
Since percutaneous nephrolithotomy (PNL) is a surgical intervention, it may show deteriorative effects on renal function in the early postoperative period. In this study, the deteriorative effects of PNL on renal function were investigated in the geriatric population, and it was compared to the non-geriatric population.A total of 711 patients [64 in the geriatric group (female/male ratio: 33/31, mean age: 70.4 +/- 4.2 years), 647 in the non-geriatric group (female/male ratio: 267/380, mean age: 40.9 +/- 12.7 years)] were included in the study. Demographic data, biochemical parameters, stone diameters, duration of the operation and estimated glomerular filtration rates (eGFR) were recorded both preoperatively and postoperatively.The eGFR ratio (post-/preoperative) was 1.13 +/- 1.00 in the geriatric group, 0.98 +/- 0.20 in the non-geriatric group (P < 0.001). Although the mean stone diameter was larger in the geriatric group than the non-geriatric group (10.08 +/- 6.5 mm, 8.28 +/- 5.54 mm, P = 0.037), the mean duration of the operation was shorter in the geriatric group than in the non-geriatric group (55.7 +/- 13.6 min, 61.3 +/- 20.9 min, P = 0.036). Hematocrit, hemoglobin, urea levels, and grade of hydronephrosis were not different between the groups.Renal function impairment is expected to be common in the geriatric patient population since they already have lower basal renal function. In the present study, the ratio of postoperative to preoperative eGFR was higher in the geriatric group. Hematocrit, hemoglobin, and urea levels and degree of hydronephrosis of these two groups did not show a great difference. The relatively short duration of the operation in the geriatric group and the diversity of perioperative and postoperative care of these two groups may explain the difference.
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Affiliation(s)
- Adem Tok
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
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Tugcu V, Su FE, Kalfazade N, Sahin S, Ozbay B, Tasci AI. Percutaneous nephrolithotomy (PCNL) in patients with previous open stone surgery. Int Urol Nephrol 2008; 40:881-4. [DOI: 10.1007/s11255-008-9376-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 03/18/2008] [Indexed: 10/22/2022]
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Olbert PJ, Hegele A, Schrader AJ, Scherag A, Hofmann R. Pre- and perioperative predictors of short-term clinical outcomes in patients undergoing percutaneous nephrolitholapaxy. ACTA ACUST UNITED AC 2007; 35:225-30. [PMID: 17786419 DOI: 10.1007/s00240-007-0112-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 08/17/2007] [Indexed: 11/30/2022]
Abstract
Percutaneous nephrolitholapaxy (PCNL) with modern stone disintegration technologies is the treatment of choice for patients with extensive stone burden or stones refractory to extracorporeal shock wave lithotripsy. However, little is known about factors predicting unfavourable outcome in terms of perioperative complications, residual stone burden or prolonged hospitalization. The aim of this study was to evaluate preoperative, patient- and stone-related parameters that might influence the perioperative course and short-term clinical outcomes. In a prospective study, age, sex, body mass index (BMI), bidimensional size, side, pre-existent urinary tract infection, pre-existent hydronephrosis and previous kidney surgery were used as independent variables in both univariate and multiple regression models in 109 PCNL patients in order to predict the partition of patients rendered stone free at hospital discharge, duration of surgery, length of inpatient hospital stay and the occurrence of major complications. Univariate and multiple regression analysis revealed that stone size was the only factor influencing duration of surgery (P < 0.001) and hospitalization (P = 0.02), but had no predictive potential for major complications. Univariate analysis showed a trend towards longer inpatient hospital stay and clinically relevant residuals in patients with lower BMI (P = 0.05 and 0.06); however, after controlling for the other confounding variables, this was only reproducible for residual stone burden. The other patient- and stone-related factors did not adversely affect the outcome measures. In our patient sample treated with PCNL by LithoClast Master/Ultra we found evidence that large stone burden is a prognostic factor predicting longer surgery and prolonged hospitalization. In addition, patients with lower BMIs might be at higher risk of not being stone free at hospital discharge accompanied by prolonged inpatient treatment.
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Affiliation(s)
- Peter J Olbert
- Department of Urology and Pediatric Urology, Philipps-University Medical School, Baldingerstr, 35043 Marburg, Germany.
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Sofikerim M, Demirci D, Gülmez I, Karacagil M. Does Previous Open Nephrolithotomy Affect the Outcome of Percutaneous Nephrolithotomy? J Endourol 2007; 21:401-3. [PMID: 17451330 DOI: 10.1089/end.2006.0293] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine the effects of previous open nephrolithotomy on the results and morbidity of subsequent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Between March 2005 and January 2006, 89 patients underwent PCNL at our institution. We compared the patients who had had previous open surgery on the same kidney (group 1; n = 27) with those who had had no previous surgery (group 2; n = 62). The two groups did not differ significantly in age (45.4 v 44 years), stone burden (361.3 mm(2) v 482.4 mm(2) ), stone number, or laterality. Operative time, hospital stay, success rate, visual analog pain scores 8 hours after surgery, analgesic doses (diclofenac sodium), and intraoperative and postoperative complications were compared. RESULTS There were no differences in operating time, postoperative analgesic doses, pain scores, intraoperative and postoperative complications, the number of accesses, or the stone-free rate. CONCLUSIONS The morbidity and efficacy of PCNL are similar in patients who have had previous open nephrolithotomy and those having no previous surgery. Previous open surgery does not affect the success of PCNL.
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Affiliation(s)
- Mustafa Sofikerim
- Department of Urology, Erciyes University, School of Medicine, Kayseri, Turkey
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Basiri A, Karrami H, Moghaddam SMH, Shadpour P. Percutaneous nephrolithotomy in patients with or without a history of open nephrolithotomy. J Endourol 2003; 17:213-6. [PMID: 12816582 DOI: 10.1089/089277903765444320] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Whether a history of open nephrolithotomy affects the efficacy and morbidity of percutaneous interventions remains unsettled. We investigated this issue in our patients. PATIENTS AND METHODS A series of 51 men and 14 women who had undergone nephrolithotomy at least once (group A; mean age 40 years) were compared with 73 men and 44 women submitting to percutaneous nephrolithotomy (PCNL) as their first surgery (group B; mean age 43 years). All patients were operated on by the same surgeons over the same period of time. Fifty patients (81.5%) in group A harbored a single stone, whereas 35.9% of patients in group B had single stones (P < 0.001). However, the two groups were similar in terms of stone laterality, the right:left ratio being 1.03 in group A and 0.67 in group B (P = 0.22). RESULTS The proportion of patients in whom PCNL failed to clear all the stones even though access was obtained did not differ in the two groups (6.15% in group A and 8.55% in group B; P = 0.77). The collecting system was inaccessible in 6.2% and 5.1% of patients, respectively (P = 0.74). Pyelonephritis or abnormal bleeding occurred in similar proportions in the two groups (P = 0.72 and P = 0.74, respectively). No other surgical complications occurred in either group. CONCLUSION A history of open nephrolithotomy does not adversely affect the efficacy or morbidity of PCNL.
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Affiliation(s)
- Abbas Basiri
- Department of Urology, Labbafi Nejad Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
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