Open Access

ARTICLE

Urolithiasis in the elderly

John-Paul McCarthy, Thomas A. A. Skinner, Richard W. Norman

Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
Address correspondence to Dr. Richard W. Norman, Suite 620, 5991 Spring Garden Road, Halifax, Nova Scotia B3H 1Y6 Canada

Canadian Journal of Urology 2011, 18(3), 5717-5720.

Abstract

Objectives: Urolithiasis is an increasing problem among patients aged 80 years and older. Our objective was to compare patients aged ≥ 80 years with a younger cohort in terms of presentation and management of urolithiasis.
Methods: Patients referred to a tertiary care stone clinic for the management of urolithiasis over a 5-year period were reviewed. Clinical data from patients aged ≥ 80 years were compared with a random sample of those under 80 years.
Results: There were 26 patients aged ≥ 80 years and 102 patients in the younger cohort; mean ages were 83.5 ± 0.6 and 50.1 ± 1.3 years, respectively. The older group had more comorbidities. Younger patients most commonly presented with flank pain, whereas older patients often had atypical presentations. Patients aged ≥ 80 years had larger stones on average. Early ureteric stent insertion was more common in the elderly group (27% vs. 7%, p < 0.01). Definitive therapy for patients ≥ 80 years was most frequently percutaneous nephrolithotomy (PCNL) (23%) compared to only 9% in the younger group. In contrast, the most common definitive treatment in patients < 80 years was extracorporeal shock wave lithotripsy (ESWL) (35% vs. 8%, p < 0.01). There was no significant difference in intraoperative complications between groups. Thirty-nine percent of the elderly group were managed as outpatients. More postoperative complications were observed in the older group, but all were minor.
Conclusion: Urolithiasis in the elderly presents unique challenges due to increased comorbidities and atypical presentations, which may lead to delayed diagnosis and more complex stone disease. Elderly patients are more likely to require early ureteric stenting and definitive treatment with PCNL. Despite these complexities, most patients ≥ 80 years can be treated safely, often on an outpatient basis.

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