Ichiyanagi O et al, 2015: Age-related delay in urinary stone clearance in elderly patients with solitary proximal ureteral calculi treated by extracorporeal shock wave lithotripsy.
Ichiyanagi O, Nagaoka A, Izumi T, Kawamura Y, Kato T.
Department of Urology, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, Yamagata City, Yamagata Prefecture, Japan.
We investigated the effects of aging on the stone-free rate (SFR) after shock wave lithotripsy (SWL) for the treatment of proximal ureteral calculi. A total of 247 consecutive patients were retrospectively selected, classified into seven groups set at 10 year increments (from 20 to 90 years), and examined for SFR after SWL. According to our final analysis, 185 male and 62 female patients with an average age of 54.1 years had stones with a diameter of 11.5 mm and a density of 893.1 Hounsfield units. On average, SFR was 74.9 % at 3 months after 1.7 SWL sessions. SFR gradually reached ≥90 % for each age-group after 1.5-2 years. Median durations to achieve 50 % SFR were estimated to be 21 and 86 days for those in their 20 and 80 s, respectively. However, the difference between the two estimates was not significant (p = 0.064). The durations to achieve 50 % SFR for the other groups lay between these two estimates. Aging does not affect long-term SFR, but patients aged ≥80 years might experience delayed stone clearance within the first 12 months after SWL.
Urolithiasis. 2015 May 16. [Epub ahead of print]
Although there were no statistical differences in terms of stone-free rates in patients with different ages, there was a clear trend of delayed fragment passage in the oldest patient group.
That the ureter is particularly powerful in young individuals is well known and that this power successively decreases beyond the early childhood. For the passage of fragments it is also obvious that not only ureteral power, but also patient mobility plays a role.
I could not find the information in the article, but it is assumed that residual fragments were located in the kidney rather than in the ureter?
One interesting notation was that the stone-free rate was increased during periods up to 1.5-2 years! This observation confirms the usefulness of a conservative approach in patients with asymptomatic residuals.