Extracorporeal shock wave lithotripsy for the treatment of urinary calculi in the elderly

A large series of extracorporeal shockwave lithotripsy in the very elderly

Background:

The incidence of urinary lithiasis has been increasing in recent decades at all ages, including the elderly. In parallel, the world population is aging and there is a paucity of data on treatment of urinary stones in very elderly people. Our main objective was to evaluate the effects of extracorporeal shockwave lithotripsy (ESWL) in patients older than 75 years, and the characteristics of this population. Complications and mortality rates after this procedure in octogenarians were also described.

Methods:

We retrospectively evaluated very elderly patients who underwent ESWL at our institution from 1998 to 2015, through chart review, telephone interviews, and consultation with the municipal mortality information program. Measured outcomes included demographic and clinical data, ESWL characteristics and complications, interval between ESWL and death, and cause of death.

Results:

Demographic and treatment characteristics were similar between very elderly and younger patients who underwent ESWL during the same period. No severe complications occurred among older patients. Octogenarians treated in our cohort had a significant life expectancy when ESWL procedures were performed. Even though 38.9% of the patients passed away during the studied period, mortality occurred on average 4.38 years after the ESWL session.

Conclusions:

In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.

Safety and efficacy of retrograde intrarenal surgery in patients of different age groups

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.

Shock wave Lithotripsy in the Elderly: Our Experience Related to Literature Review

Background

The more and more common use of abdominal ultrasonography and of other imaging techniques, the increase of the life expectancy and therapies for calcium metabolism, has led to a higher diagnosis rate of renal stones in the elderly. At the moment, extracorporeal shock wave lithotripsy is considered the first-line therapy in the majority of reno-ureteral stones.

Objectives

To prove the efficacy and safety of extracorporeal shock wave lithotripsy also in the elderly population.

Materials and Methods

We proceeded to a retrospective study on patients aged over 70 years, who underwent SWL at our division from January 1996 to April 2005, with Storz Modulith SLX electromagnetic lithotripter. We defined as 'stone-free those patients who did not show any stone fragment in the following ultrasonography and abdomen X-ray control. In addition, we performed a medium/long-term follow-up. We adopted as “control group” 115 patients aged less than 60 years, who underwent lithotripsy with the same lithotripter from June 2007 to January 2008.

Results

In the short-term follow-up, at the end of the single treatment or of the course of treatments (1-3 months after treatment), we observed: 72.1% (83/115) stone-free subjects, 20% (23/115) of cases with stone fragments that could be eliminated (<4 mm), 3.5% (4/115) with stone fragments >4 mm, 4.3% (5/115) unchanged cases; 2 of these (1.7%) underwent endoscopic lithotripsy and one percutaneous lithotripsy (0.9%). Concerning the medium/long-term follow-up (mean 59.2 months, range 7 mo-108 mo), we observed: 59.8% (67/112) stone-free cases, 25.9% (29/112) recurring stones, 11.6% (13/112) re-growth, 2,7% (3/112) unchanged cases. In the short-term follow-up, comparing the study group with the control one we observed: – No statistically significant difference regarding the treatment side effects in the two groups; – A lower stone-free percentage in caliceal stones in the elderly than in the younger patients (SFR = 62.5% vs 70.3%) – A stone-free percentage for non-caliceal stones similar in the older and the young patients (SFR = 79.1% vs 80.4%).

Conclusions

Shock wave lithotripsy proves to be effective in the first-line treatment of renal stones in the elderly, yielding good results with no increase of side effects.

Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis

The aim of the study was to evaluate the impact of age on the efficacy of extracorporeal shock wave lithotripsy (SWL), in a comparative study based on the principles of matched-pair analysis. Over a period of 4 years, 2,311 patients were treated with SWL in a tertiary referral center. Patient and stone data were recorded in a prospective electronic database. Among these patients, 115 (4.97%) were older than 70 years of age and fulfilled the criteria for inclusion in the study (Group A). For the purposes of the comparative analysis, Group A patients were matched for gender and stone parameters (side, location of stone, and diameter ±2 mm) with a control group of patients under the age of 70 (Group B). Following matching, the patients' electronic medical records were reviewed, to identify SWL success rates at 3 months and McNemar's test was used to compare the efficacy of SWL between the two groups. Matching was possible in all cases. The results indicate that there were no statistically significant differences in the mean number of SWL sessions or in the mean number of impulses per session between the two groups. The overall stone clearance rate achieved by SWL alone was 71.3% for Group A and 73.9% for group B. Discordant pairs were found in 37 cases (in 17 pairs only patients in Group A became stone-free, while in 20 pairs only patients in Group B became stone-free). By using McNemar's test, the difference in stone clearance rates between the two groups was not found to be statistically significant (p = 0.742). A total of 22 patients (19.1%) in Group A and 17 patients (14.7%) in Group B underwent an adjuvant procedure to achieve stone clearance. McNemar's test also revealed the absence of any statistically significant difference in SWL success rates between older and younger patients in the subgroups of patients presenting with either ureteric or renal stones (p = 0.727 and p = 0.571, respectively). In conclusion, SWL is still considered one of the first-line tools for geriatric patients suffering from urolithiasis, as increased age alone does not seem to adversely affect the efficacy of SWL.

Shock-wave lithotripsy in the elderly: Safety, efficacy and special considerations

Purpose

Shock-wave lithotripsy (SWL) for elderly patients can be challenging. Patients often have a long-standing complex stone burden and significant comorbidities. We report a cohort of patients aged ⩾70 years who were treated by SWL, with special attention to treatment outcomes, complications and the need for adjuvant procedures.

Patients and methods

Over a period of 4 years, 2311 patients were treated with SWL in a tertiary referral centre. Among these patients, 137 were aged ⩾70 years (5.9%). Patient and stone data were obtained from an electronic database and the patients’ electronic medical records were reviewed.

Results

During the pre-procedural assessment, 29 patients (21.2%) were considered to be at high anaesthetic risk, due their comorbidities (American Society of Anesthesiology score 3+). In terms of stone burden, 16 stones (11.7%) were located in the distal ureter (mean stone diameter 7.9 mm) and 28 (20.4%) were in the proximal ureter (mean diameter 10.1 mm). In the kidney, 54 stones (39.4%) were in the renal pelvis, upper or mid calyx (mean diameter 10.6 mm), while 39 stones (28.5%) were in the lower calyx (mean diameter 10.1 mm). The median (range) number of SWL sessions per patient was 2.0 (1–3). The overall stone-free rate achieved by SWL alone was 63.5% (65.9% for ureteric stones and 62.4% for renal stones). In total, 38 patients (27.7%) had an adjuvant procedure to achieve stone clearance (ureteroscopy in 23, PCNL in 14 and laparoscopic ureterolithotomy in one case). Apart from six cases (4.3%) of ureteric obstruction due to steinstrasse, there were no severe complications noted.

Conclusions

The management of elderly patients presenting with urolithiasis is challenging, due to the presence of significant comorbidities. Careful assessment of an integrated management plan for geriatric patients with urolithiasis is essential, and SWL still remains a safe and efficient first-line tool in well-selected cases.

Extracorporeal shock-wave lithotripsy of renal calculi

Extracorporeal shock-wave lithotripsy (ESWL) is a noninvasive technique that utilizes focused shock waves to fragment stones into sand-sized particles, which then pass spontaneously with urination. The clinical use of this technique was introduced in 1980 in Germany by Chaussy and associates and has replaced most open surgery and percutaneous endoscopy for stone removal. The physics of shock waves, equipment, techniques, and patient selection in ESWL are discussed. Results of treatment of renal, upper ureteral, and lower ureteral calculi are reviewed and compared. Complications of treatment, including ureteral obstruction, hemorrhage, and tissue damage, are discussed. The advent of second-generation lithotripters has widened the parameters for patient selection in the treatment of ESWL and has increased the availability of this treatment modality.