Is percutaneous nephrolithotomy effective and safe in elderly patients? Outcomes of a case-control study

A. Mangiatordi 1, M. Auciello 1, G. Stallone 2, A. Saita 3, A. Hoznek 4, L. Cormio 1

1 Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy; 2 Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy; 3 Urology, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; 4 Department of Urology, Henri Mondor Hospital, Créteil, France

Background and aims. Percutaneous nephrolithotomy is the recommended treatment option for large or otherwise complex renal or proximal ureteral stones. Being a challenging procedure, its efficacy and safety in elderly patients is questioned. The present study aimed to determine the impact of age on percutaneous nephrolithotomy outcome, comparing patients < 70y with those ≥ 70y. 

Methods. We analysed our prospectively maintained Internal Review Board approved database on percutaneous nephrolithotomy to compare demographics, perioperative outcomes and postoperative complications of patients < 70y with those of patients ≥ 70y.

Result. Among 638 patients treated between April 2005 and March 2018, 553 were < 70y and 85 were ≥ 70y. There was no difference between the two populations in all preoperative characteristics but American Society of Anaesthesiologists score, which was significantly worse in elderly patients. Operative outcomes were similar in the 2 populations but elderly patients had a greater complications rate (54.1 vs 42%; p = 0.005) and a higher rate (9.4 vs 4.2%; p = 0.0525) of infective complications. Indeed, multivariate analysis showed that age > 70y and positive stone culture were associated with a significantly higher rate of clinically-significant complications.

Conclusions. Percutaneous nephrolithotomy proved to be effective in consecutive/unselected elderly (≥ 70y) candidates to such procedure but at the price of a greater risk of, mainly minor, complications. The higher incidence of infective complications speaks for potentially reduced immune response of such patients and sets the rationale for further addressing this issue.

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