Open Access

ARTICLE

Supine percutaneous nephrolitotripsy in septuagenarian and octogenarian patients: outcomes of a case-control study

Fábio C. M. Torricelli, Guilherme K. M. Ogawa, Fábio C. Vicentini, Giovanni S. Marchini, Alexandre Danilovic, Miguel Srougi, William C. Nahas, Eduardo Mazzucchi

Division of Urology, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
Address correspondence to Dr. Fábio César Miranda Torricelli,Av.VereadorJoséDiniz,3300,conj.208,SãoPaulo (SP) — CEP 04604-006

Canadian Journal of Urology 2018, 25(2), 9245-9249.

Abstract

Introduction: Currently, there is limited data evaluating the outcomes of supine percutaneous nephrolithotomy (PCNL) in septuagenarian and octogenarian patients. This study aims to compare the perioperative outcomes of supine PCNL in elderly patients (≥70 years) with those of a younger population (<70 years). Materials and methods: A matched case-control study was conducted from January 2009 through December 2015 using our prospectively maintained kidney stone database. The case group consisted of patients aged over 70 years, while the control group included patients under 70 years. Patients were randomly matched based on Guy’s Stone Score as a surrogate for procedural complexity. Results: A total of 54 patients were enrolled in the study: 18 in the case group and 36 in the control group. There were no significant differences between the groups in terms of gender or body mass index. However, there were significantly more ASA class III patients in the elderly group (p = 0.012). The mean Charlson comorbidity index was also significantly higher in septuagenarian and octogenarian patients (p = 0.041). With regard to PCNL technique, no significant differences were observed in the number of access tracts, supra-costal access rates, or operative time. Similarly, there were no significant differences in stone-free rate, duration of nephrostomy tube placement, complication rate, mean decrease in hemoglobin level, or need for blood transfusion. However, hospital stay was significantly longer in the elderly group (4.0 ± 1.7 vs. 2.4 ± 1.1 days; p = 0.002). Conclusion: Septuagenarian and octogenarian patients undergoing supine PCNL have comparable complication rates and stone-free rates to younger patients. However, they tend to require a longer hospital stay, likely due to higher baseline comorbidities. These findings support the feasibility and safety of supine PCNL in carefully selected elderly patients.

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