Is percutaneous nephrolithotomy effective and safe in elderly patients? Outcomes of a case-control study| JOURNAL OF GERONTOLOGY AND GERIATRICS

Abstract

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.