PCNL Safe for Elderly Kidney Stone Patients

BANFF, Alberta—Older adults can safely undergo percutaneous nephrolithotomy (PCNL), researchers reported at the Canadian Urological Association annual meeting.

In a study, the average operative time, post-procedure stone-free rate, complication rate, and hospital length of stay were similar for patients aged 70 and older and for young patients.

“We look at surgical management of stones more favorably in the elderly population than we did before conducting our study,” said lead investigator Shubha De, MD, after presenting the findings. “We also continue to manage older patients in the same way we do younger patients, including using two general anesthetics and one conscious sedative, and using prone positioning.”

The aging population brings with it more patients with several medical comorbidities including those with kidney stones, sepsis, and renal deterioration. Hence, Dr. De and his colleagues retrospectively compared 28 patients over 70 years of age to 20 stone-size-matched and age-adjusted controls to examine whether older patients have worse outcomes.

They drew the two groups of patients from 231 patients who underwent PCNL by Dalhousie University urologists in Halifax, Nova Scotia. The older patients had an average age of 78.6 years and the younger patients' average age was 47.1. The older group had a higher average American Society of Anesthesiologists score and more comorbidities than the younger group (2.86/patient vs. 1.10/patient). Furthermore, more of the elderly individuals had cardiac disease and cancer.

The two groups' rates of urosepsis and recurrent urinary-tract infections were similar. The average stone diameter in the elderly and younger patients also was comparable, at 1.73 and 1.89 cm, respectively, as was the average number of stones, at 2.16 and 1.60, respectively. The stone composition also was similar in both groups, with the majority being made of calcium oxalate.

Intraoperatively, the majority of patients in both groups had PCNL performed on their right side and a similar, low rate of dual access. The average operating-room time was also similar, at 72.5 minutes among the elderly and 84.9 minutes in the controls. For post-operative drainage, more patients in both groups had a nephrostomy tube and a urethral catheter than either a urethral catheter alone or a nephrostomy tube and a urethral stent.

The elderly group's stone-free rate was 63.3% and that in the control group was 74%; this is a non-statistically significant difference. The lengths of stay also were similar, at 2.37 days and 3.21 days, respectively. The 30-day complication rates also were statistically similar, at 33%and 15%, respectively.

“Age alone should not be an exclusion criterion for PCNL, concluded Dr. De, who was a urology resident at Dalhousie and started a fellowship at the Cleveland Clinic at the beginning of July 2012. “Concerns regarding multiple anesthetics, prone positioning, bleeding, and hospitalization should be considered individually, rather than in terms of second-line management based on advanced age.”

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