To investigate the efficacy and safety of ureteroscopic lithotripsy (URSL) in young, old-old, and oldest old patients.
Materials and Methods:
We enrolled 157 patients who underwent URSL. We divided the patients into young (<65 years), old-old (65–84 years), and oldest old (≥85 years) groups and compared the safety of surgery between young vs old-old and young vs oldest old, separately.
Results:
In the <65 group, 65 to 85 group, and ≥85 group, respectively, the mean stone diameters were 8.9 ± 4.9, 10.8 ± 7.7, and 11.4 ± 6.3 mm; mean operative time was 76.6 ± 33.1, 86.7 ± 44.7, and 84.0 ± 44.5 min; the stone-free rates were 95.9%, 94.4%, and 96.3%; and the complication rates were 8.2%, 9.8%, and 3.7%.
Conclusions:
In this study, we showed the feasibility and safety of URSL for elderly people. Although oldest old (≥85 years) people had multiple comorbidities with low performance status, URSL could be performed with acceptable complication rates. Clinical Trial Registration Number: 1809-1
Get full access to this article
View all access options for this article.
References
1.
AkmanT, BinbayM, UgurluM, et al.Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: A matched-pair analysis. J Endourol, 2012; 26:625–629.
2.
YoshiokaT, OtsukiH, UeharaS, et al.Effectiveness and safety of ureteroscopic holmium laser lithotripsy for upper urinary tract calculi in elderly patients. Acta Med Okayama, 2016; 70:159–166.
3.
HuH, LuY, HeD, et al.Comparison of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of intermediate proximal ureteral and renal stones in the elderly. Urolithiasis, 2016; 44:427–434.
4.
BerardinelliF, De FrancescoP, MarchioniM, et al.RIRS in the elderly: Is it feasible and safe?. Int J Surg, 2017; 42:147–151.
5.
PrattleyS, VossJ, CheungS, et al.Ureteroscopy and stone treatment in the elderly (≥70years): Prospective outcomes over 5- years with a review of literature. Int Braz J Urol, 2018; 44:750–757.
6.
FornaraP, DoehnC, FreseR, et al.Laparoscopic nephrectomy in young-old, old-old, and oldest-old adults. J Gerontol A Biol Sci Med Sci, 2001; 56:287–291.
7.
HaberalHB, GudelogluA, DegerM, et al.Percutaneous nephrolithotomy in young-old, old-old, and oldest-old patients: A multicenter study. J Laparoendosc Adv Surg Tech A, 2021; 31:796–802.
8.
StroumbakisN, HerrHW, CooksonMS, et al.Radical cystectomy in the octogenarian. J Urol, 1997; 158:2113–2117.
9.
NevoA, ManoR, BanielJ, et al.Ureteric stent dwelling time: A risk factor for post-ureteroscopy sepsis. BJU Int, 2017; 120:117–122.
10.
YukHD, ParkJ, ChoSY, et al.The effect of preoperative ureteral stenting in retrograde intrarenal surgery: A multicenter, propensity score-matched study. BMC Urol, 2020; 20:147.
11.
JessenJP, BredaA, BrehmerM, et al.International collaboration in endourology: Multicenter evaluation of prestenting for ureterorenoscopy. J Endourol, 2016; 30:268–273.
12.
YangY, TangY, BaiY, et al.Preoperative double-J stent placement can improve the stone-free rate for patients undergoing ureteroscopic lithotripsy: A systematic review and meta-analysis. Urolithiasis, 2018; 46:493–499.
AbrahamsHM, StollerML. The argument against the routine use of ureteral access sheaths. Urol Clin North Am, 2004; 31:83–87.
15.
TraxerO, Wendt-NordahlG, SodhaH, et al.Differences in renal stone treatment and outcomes for patients treated either with or without the support of a ureteral access sheath: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study. World J Urol, 2015; 33:2137–2144.
16.
BlackmurJP, MaitraNU, MarriRR, et al.Analysis of factors' association with risk of postoperative urosepsis in patients undergoing ureteroscopy for treatment of stone disease. J Endourol, 2016; 30:963–969.
17.
PremingerGM, TiseliusHG, AssimosDG, et al.American Urological Association Education and Research, Inc; European Association of Urology. 2007 guideline for the management of ureteral calculi. Eur Urol, 2007; 52:1610–1631.
18.
GeavleteP, GeorgescuD, NiţăG, et al.Complications of 2735 retrograde semirigid ureteroscopy procedures: A single-center experience. J Endourol, 2006; 20:179–185.
19.
CastroEP, OstherPJS, JingaV, et al.; CROES Ureteroscopy Global Study Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: The Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol, 2014; 66:102–109.
20.
BhojaniN, MillerLE, BhattacharyyaS, et al.Risk factors for urosepsis after ureteroscopy for stone disease: A systematic review with meta-analysis. J Endourol, 2021; 35:991–1000.
21.
DasguptaR, CameronS, AucottL, et al.Shockwave lithotripsy versus ureteroscopic treatment as therapeutic interventions for stones of the ureter (TISU): A multicentre randomised controlled non-inferiority trial. Eur Urol, 2021; 80:46–54.
22.
SkolarikosA, AlivizatosG, de la RosetteJ. Extracorporeal shock wave lithotripsy 25 years later: Complications and their prevention. Eur Urol, 2006; 50:981–990.
23.
Al-AnsariA, As-SadiqK, Al-SaidS, et al.Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones. Int Urol Nephrol, 2006; 38:63–67.
24.
Abdel-KhalekM, SheirKZ, MokhtarAA, et al.Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones—a multivariate analysis model. Scand. J. Urol. Nephrol, 2004; 38:161–167.
25.
MazzonG, PavanN, ChiapparroneG, et al.Factors predictive of shockwave lithotripsy failure for ureteral stones: Why we need to hurry. Minerva Urol Nefrol, 2019; 71:644–650.
