Safety and efficacy of percutaneous nephrolithotomy in

patients aged 70 or older

G. Burtea1, F. Varzescu1, Y. Salaheddin1, R. Petca1,2, V. Jinga1,2, B. Braticevici1,2
1 Dep. of Urology, Prof. Dr. Th. Burghele Clinical Hospital, Bucharest, Romania
2 University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

| Introduction
Percutaneous nephrolithotomy (PCNL) is still required for complex or bulky renal lithiasis, although it is a more aggressive
intervention than extracorporeal shock wave lithotripsy (ESWL) in elderly patients, due to the high prevalence of comorbidity. Our
objective was to assess the safety and efficacy of percutaneous nephrolithotomy in patients over 70 years old.

| Methods Patients characteristics

Sex ratio 43 womens 37 mens
Between 01 July 2016 - 31 July 2017, 681 patients in our
Average age 75.38 years 70 80 years
clinic underwent PCNL for renal lithiasis . This study
included a number of 80 patients over 70 years old UTI 34 UTI 47 without UTI
(women/men 43/37). We retrospectively reviewed Bacteria 15 E. Coli 8 Klebsiella 1 MRSA
perioperative and postoperative data of patients, analyzing 8 Enteroccocus 2 Pseudomonas 1 Candida
population characteristics, stones characteristics, Stones type 17 Staghorn 15 (2 or more 48 (single
intervention, complications, stone free rates and calculi ) calculus)
postoperative hospital stay. Average age of the lot was Hydronephrosis 56 HN 24 without HN
75.38 years (70 - 86 years). Staghorn calculi represented Comorbidities
21,25 % (17). 42,5%(34) had UTI at admission, E.Coli HTA 38% HTA 31 CKD 20 PCa 4
most common pathogen (18,75%). Most frequent CIC 25% CIC 20 S. Kidney 4 Stroke 4
comorbidities were: HTA (31), CIC(25), Diabetes(20), Diabetes 25% Diabetes 20 Obesity 17 Ch. Gastritis 3
CKD(20), Obesity (17). IRC 25% Tachycardia 5
Obesity 21,25%

Postoperative results | Results

Calyceal 75 lower 8 upper
9 middle calyx On postoperative imagistic follow-up , stone free rate was 76,25
aproach calyx calyx
%. 9 (11,25%) of the patients presented residual stones which
Stone free rate 76,25 % required another PCNL intervention while 10 (12,5%) undewent
SWL for residual lithiasis located in upper and middle calyx. Most
Drainage 85% internal 15% external used calyx for puncture was inferior calyx (75), followed by middle
calyx (9). 12 patients (15%) had ureteral stent for 48 hours, while
Internal tipe of 83,75% JJ stent 16,25% uretheral the majority had JJ stent for 10-14 days. Postoperative admission
drainage stent
time was 6,49 days. We analysied complications according to
Hospitalization Average 6,49 days 2-21 days clavien dindo classification and encountered: grade 1 in 22
patients, grade 2 in 23, grade 3 in 4 and 1 patient presented grade
4 complication. There were no reported deaths.
Complications (Clavien-Dindo scale)
I 13 transient elevation of serum creatinine | Conclusions
(16,25%)
9 fever (11,25%) Percutaneous nephrolithotomy in elderly patients has indications.
II 15 UTI (18,75%) The majority of complications after PCNL are minor, it can be
5 blood transfusion (6,25%) performed safely with minimal risks , but it depends on the
2 clostridium difficile infection (2,5%) experience of the surgeon.
1 Upper gastrointestinal bleeding (1,25%)
III 2 endovascular embolization (2,5%)
2 colic due to blood cloots (2,5%)
IV 1 urosepis (1,25%)