The Impact of Comorbidities on the Efficacy of Percutaneous Nephrolitotomy (PCNL) in Elderly Patients

Open access


Introduction: The objective of this study is to evaluate the efficacy and safety of PCNL as a method of treatment of renal stones in elderly patients.

Material and method: This was a retrospective study conducted over a period of 5 years in the Clinic of Urology, where we analyzed the surgical protocols and case reports of 56 patients who underwent PCNL intervention.

Results: The incidence of urolithiasis was higher in females 69.6% (n = 39) than in males 30.4% (n = 17). Comorbidities included hypertension (48.2%), chronic ischemic cardiopathy (28.6%), chronic cardiac failure (16.1%), type II diabetes (17.9%), obesity (39.3%), chronic renal failure (8.9%), chronic or recurrent urinary tract infections (30.4%), history of kidney stones (21.4%), solitary kidney surgery (1.8%), renal malformation (horseshoe kidney and renal incomplete duplication) (3.6%), urethral stricture (3.6%). Nine patients had a duble “J” catheter inserted on admission. The group of male patients presented prostate hyperplasia in 35.3% of the cases and prostate carcinoma in 5.9% of the cases.

Conclusions: PCNL is an effective and safe treatment of kidney stones in elderly patients, with a stone- free rate increased despite existing comorbidities. The presence of comorbidities requires careful preoperative evaluation. PCNL in elderly patient has similar results to those seen in younger patients.

1. Smith LH. The medical aspects of urolithiasis: an overview. JUrol. 1989;141:707.

2. Dursum M, Ozbek E, Otunctemur A, et al. Clinical presentation of urolithiasis in older and younger population. Archivio Italiano di Urologia e Andrologia 2014;86(4):249-252.

3. Duchene DA, Pearle MS. Stone and endourology in older adults. Geriatric Urology by Tomas Lindor Griebling, Ed. Springer, New York 2014;357-366

4. McCarthy J-P, Skinner TA., Norman RW, et al. Urolithiasis in the elderly. The Canadian Journal of Urology 2011;18:5717-5720.

5. Vicenti F, Gomes CM, Danilovic A, et al. Percutaneous nephrolithotomy: current concept. Indian Journal of Urology. 2009;25:4-10.

6. Al-Kohlany KM, Shokeir AA. Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol. 2005;173:469-473.

7. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur. Urol. 2001;40:362-371.

8. Tugcu V, Su FE, Kalfazade N, et al. Percutaneous nephrolithotomy in patients with previous open stone surgery. Int. Urol. Nephrol. 2008;40:881-884.

9. Anagnostou T, Thompson T, et al. Safety and outcome of percutaneous nephrolithotomy in the elderly: retrospective comparison to a younger patient group. J Endourol. 2008;22:2139-2145.

10. Nakamon T, Kitirattrakarn P, Lojanapiwat B. Outcomes of percutaneous nephrolithotomy: comparison of elderly and younger patients. IBJU 2013;39:692-701.

11. Karami H, Mohsen M, Golshan A, et al. Does age affect outcomes of percutaneous nephrolithotomy? J Urol. 2010;7:17-21.

12. Kuzgunbay B, Turune T, Yaycioglu O, et al. Percutaneous nephrolithotomy for staghorn kidney stones in elderly patients. Int Urol Nephrol. 2011;43:639-643.

13. Soucy F, Ko R, Duvdevani M, et al. Percutaneous nephrolithotomy for staghorn calculi: a single center’s experience over 15 years. J Endourol. 2009;23:1669-1373.

14. Dorè B, Conort P, Irani J, et al. Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70: a multicenter retrospective study of 210 cases. Prog Urol. 2004;14:1140-1145.

15. Kamphuis GM, Baard J, de la Rosette JJ, et al. Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol. 2015;33:223-233.

16. Fuller A, Razvi H, Denstedt JD, et al. The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. J Urol. 2012;188:138-144.

17. Tomaszewski JJ, Smaldone MC, et al. Outcomes of percutaneous nephrolithotomy stratified by body mass index. J Endourol. 2010;24):547-550.

18. Torrencila OC, Meza Martinez A, Vicens Morton AS, et al. Obesity in percutaneous nephrolithotomy. Is body mass index really important? J Urol. 2014;84:538-543.

19. Sahin A, Atsü N, Erdem E, et al. Percutaneous nephrolithotomy in patients aged 60 years or older. J Endourol. 2001,15:489-491.

20. Stuard Wolf J. Percutaneous approaches to the upper urinary tract collecting system, in: Kavoussi LR, Novick AC, Partin AW: Urology, 10th ed., Elsevier, 2012;47:1324-1356.

Acta Medica Marisiensis

The Journal of The University of Medicine and Pharmacy of Targu-Mures

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 115 97 7
PDF Downloads 69 65 10