Lamacchia GB. et al., 2019: A large series of extracorporeal shockwave lithotripsy in the very elderly
Lamacchia GB, Korkes F, Baccaglini W, de Mello LGM, Szwarc M, Tobias-Machado M.
Discipline of Urology, Faculdade de Medicina do ABC, Santo André, SP, Brazil.
Department of Urology, Hospital São Luiz Jabaquara, São Paulo, SP, Brazil.
Abstract
Background: The incidence of urinary lithiasis has been increasing in recent decades at all ages, including the elderly. In parallel, the world population is aging and there is a paucity of data on treatment of urinary stones in very elderly people. Our main objective was to evaluate the effects of extracorporeal shockwave lithotripsy (ESWL) in patients older than 75 years, and the characteristics of this population. Complications and mortality rates after this procedure in octogenarians were also described.Methods: We retrospectively evaluated very elderly patients who underwent ESWL at our institution from 1998 to 2015, through chart review, telephone interviews, and consultation with the municipal mortality information program. Measured outcomes included demographic and clinical data, ESWL characteristics and complications, interval between ESWL and death, and cause of death.Results: Demographic and treatment characteristics were similar between very elderly and younger patients who underwent ESWL during the same period. No severe complications occurred among older patients. Octogenarians treated in our cohort had a significant life expectancy when ESWL procedures were performed. Even though 38.9% of the patients passed away during the studied period, mortality occurred on average 4.38 years after the ESWL session.Conclusions: In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.
Ther Adv Urol. 2019 Aug 20;11:1756287219870412. doi: 10.1177/1756287219870412. eCollection 2019 Jan-Dec. FREE ARTICLE
Comments 1
During 17 years 33 938 patients in Brazil were treated with SWL. Of these patients 371 (~1%) were older than 75 years. In the latter group 602 treatments were carried out. The total number of procedures in the whole group of SWL-treated patients was 54 298 which gives an average of 1.6 treatments per patient. It is of note that this number was the same for old patients (1.62). This re-treatment rate is slightly higher than I personally expected.
Interestingly in the group of old patients, 10% had their first stone diagnosed after the age of 70.
It is important to note that SWL made it possible to treat patients who, as a consequence of their age and health condition, not previously had been possible to treat because of anaesthetic and surgical risks. None of the deaths recorded following SWL was caused by the treatment.
There were, unfortunately, no follow-up data on treatment results but it can be assumed that the majority of these patients were at least rendered asymptomatic. The following lithotripters had been used: MFL 9000, Dornier Dolis, Dornier Compact Sigma and Dornier Gemini.
It is well recognized, but seldom mentioned, that SWL has expanded the range of indications for stone removal making it possible to eliminate stones and/or symptoms in patients, for whom alternative methods were considered too risky or impossible to use. This was an observation that the reviewer made already in the very beginning of the SWL-era more than 30 years ago.