[THE OPERATIVE AND POSTOPERATIVE RESULTS OF PERCUTANEOUS NEPHROLITHOTOMY FOR THE ELDERLY IN COMPARISON TO A YOUNGER POPULATION].

Abstract

Introduction: Kidney stone disease is very common in the western world and combined with the aging of the population, it brings about the need to treat older patients with numerous comorbidities. Percutaneous nephrolithotomy (PCNL) is the standard of care for patients with stones 2 cm and above but is more invasive. Thus, with the elderly patient comes the dilemma: whether to choose the percutaneous path or to proceed with ureteroscopy even at the cost of several procedures in order to complete the task at hand. Recent developments also added the choice of smaller working channels and the options of choosing a standard channel (30f) and faster surgery or using a miniaturized one perhaps with slower surgery with possible side effects.

Aims: To estimate the efficacy and safety of a standardized PCNL in the elderly population in comparison to younger patients undergoing the same procedure.

Methods: A single center retrospective study was conducted of all the patients who underwent a standardized PCNL for kidney stones during the years 2019-2023. All demographical and clinical data were gathered.

Results: The study population included 81 patients, of whom 18 (22%) were in their seventies and 63 (78%) were under 70 years of age. As expected, the older group had a higher Charlson Comorbidity Index and a higher ASA score (p=0.003, p<0.001 respectively). The diameter of the largest stone was 2.2 cm with no differences between the two groups (p=0.995), nor in stone number, location volume or density. Procedure time, hemoglobin level and kidney function after surgery were similar. Residual stone fragments per non-contrast CT a day after the procedure did not differ between the groups (a median size of 2 mm in the younger group vs. 1.5 mm). The elderly group spent more time in the hospital (5 days vs. 4, p=0.023), but there were no differences in complications.

Conclusions: A standardized PCNL can be performed safely and effectively in the elderly without significant differences in comparison to younger patients. Chronological age alone should not take the percutaneous option off the table for an elder with a large kidney stone.