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Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Veronica Ghirca and Orsolya Mártha

Abstract

Introduction and objectives: Percutaneous nephrolithotomy represent the main indication for patients with kidney stones, even in the presence of various comorbidities. In our clinic open surgery for this pathology is less than 0.5% of all procedures for renal stones. The objective of this paper is to assess the safety and efficacy of this procedure in patients over 70 years.

Material and methods: A retrospective study was performed for a period of 16 years (1997-2012). A totally of 323 patients entered in this study (162 women, 161 men), aged over 70 and with renal stones They were treated endoscopically by percutaneous nephrolithtomy or anterograde ureteroscopy. 85 patients (26.31%) had comorbidities that were preoperatively diagnosed and treated where necessary.

Results: Overall status of “stone free” at the end of surgery was present in 263 patients (81.42%). 60 patients (18.58%) had residual fragments. Residual stones were solved by a new percutaneuos nephrolithtomy session, spontaneous elimination or extracorporeal shock wave lithotripsy. The most common complications were bleeding and infection. We had no deaths. No hemostasis nephrectomy was necessary.

Conclusions: Recognized preoperative comorbidities do not represent risk factors in elderly patients, but it requires a rigorous evaluation in the preoperative period. The number, size and complexity of stones directly influences the state “stone free” at the end of surgery.

Open access

Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Oliver Vida and Orsolya Mártha

Abstract

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.

Open access

Adrian Maier, Adrian Man, Călin Chibelean, Teodora Cighir, Eniko Nemes-Nagy, Ioana Maier, Ciprian Todea, Oliver Vida and Orsolya Martha

Abstract

Objective: To evaluate the bacteriological features in non-struvite nephrolithiasis and in its associated urinary tract infection, and to establish the relationship between the two pathologies.

Methods: The non-struvite calculi from 132 patients were aseptically extracted by percutaneous nephrolithotomy (PNL). The midstream urine and calculi were bacteriologically and biochemically processed.

Results: Most calculi (78%) were located to renal pelvis, associated with hydronephrosis, the biochemical composition confirming the lack of struvite and revealing the predominance of calcium oxalate. The females presented significantly more colonized calculi (50%) than males (21.9%), with higher bacteriological diversity. There is a significant relation between the presence of colonized calculi and urinary tract infections, 24.2% of calculi and 25.8% of the urine samples presenting positive cultures. In 70.4% of cases, we found the same antibiotic resistance pattern between the pathogens isolated from calculi and urine, thus considering them identical strains. The Enterobacteriaceae represented the most predominant bacteria both from calculi (62.5%) and urine (63.6%), approximatively 30% being resistant to cephalosporins and over 50% resistant to fluoroquinolones, ampicillin and tetracycline. There were 3.8% of cases in which the calculi were colonized but the urine was sterile, the bacteria being sensitive to cephalosporins that are used as prophylaxis.

Conclusions: In all the cases, the same bacterial species was found both in calculi and urine, and 70.4% of them were phenotypically identical. The resistance to the second generation cephalosporins is lower than in the case of other antibiotics, which makes them the most suitable for prophylaxis in PNL.