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Schulz AE, Green BW, Gupta K, Patel RD, Loloi J, Raskolnikov D, Watts KL, Small AC. Management of large kidney stones in the geriatric population. World J Urol 2023; 41:981-992. [PMID: 36856833 DOI: 10.1007/s00345-023-04333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE The aim of this review is to highlight the unique factors that predispose geriatric patients to nephrolithiasis and to compare the utility and efficacy of surgical techniques in this specific patient population. METHODS PubMed and EMBASE databases were reviewed, and studies were organized according to surgical treatments. RESULTS Few prospective studies exist comparing kidney stone removal in the elderly to younger cohorts. In addition, various age cut-offs were used to determine who was considered elderly. Most studies which analyzed Percutaneous Nephrolithotomy (PCNL) found a slightly higher rate of minor complications but comparable stone free rate and operative time. For ureteroscopy (URS) and extracorporeal shockwave lithotripsy (ESWL), there were minimal complications observed and no difference in clinical success in the elderly. All surgical techniques were presumed to be safe in the elderly and most found no difference in stone-free rates. CONCLUSIONS Unique attributes of the geriatric population contribute to stone formation and must be considered when determining appropriate management modalities. This review provides an overview of the utility and efficacy of PCNL, URS and ESWL in the elderly, as well as a porposed algorithm for management in this population.
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Affiliation(s)
| | | | - Kavita Gupta
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Rutul D Patel
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Justin Loloi
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Dima Raskolnikov
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Kara L Watts
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Alexander C Small
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA.
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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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Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups. Int Urol Nephrol 2020; 52:2229-2236. [PMID: 32676812 DOI: 10.1007/s11255-020-02564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effects of aging on the success rate of retrograde intrarenal surgery (RIRS) and the development of medical and surgical complications by dividing geriatric patients into subgroups based on their chronological age. METHOD Data of the patients who underwent RIRS due to kidney stones at our clinic between June 2014 and January 2020 were retrospectively reviewed. Patients were divided into three groups based on age: 65-74 years (Group 1), 75-84 years (Group 2), and ≥ 85 years (Group 3). The comorbid diseases of patients were evaluated using the Charlson Comorbidity Index (CCI), total Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score, and CIRS severity index (CIRS-G SI). RIRS success rates and complications were evaluated based on age groups. RESULTS A total of 336 patients were included in the study. The mean age of the patients was 72.7 ± 6.59 years. Stone-free rate was 81.5% in patients aged > 65 years and did not change with age. The modified Clavien-Dindo grade I/II complication rates for surgical complications were similar in all three groups (p = 0.818). In the evaluation of ROC analysis for medical complications, it was observed that the cut-off values were 76.5 years, CIRS-G score of 4.5, CCI score of 2.5, and CIRS-SI score of 1.18 (p < 0.001). CONCLUSION RIRS is an effective and safe treatment option for kidney and proximal ureteral stones in geriatric patients. Although there is an increase in medical complications post-RIRS with aging, surgical complications and stone-free rates remain unchanged.
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