Ozer C. et al.: Clinical results of shock wave lithotripsy treatment in elderly patients with kidney stones: Results of 1433 patients
Ozer C, Tekin MI.
Department of Urology, Baskent University, Adana.
Objective: In this study, it was aimed to evaluate the efficacy and safety of SWL treatment in elderly patients with kidney stones.
Materials and methods: Data from a total of 3024 patients who underwent SWL treatment for urinary tract stone disease in three centers of our university were evaluated retrospectively. A total of 1433 patients in the adult age group treated for single kidney stones were included in the study. The patients were divided into 3 groups (18-40, 41-64 and ≥ 65) years depending on their age. Demographic data, stone parameters, stone-free rate (SFR) and clinically insignificant residual fragment (CIRF) rate, number of SWL sessions and complication rate were analyzed according to the age groups.
Results: The mean age of the patients was 47.38 ± 13.24 years. Stone size was significantly lower in the 18-40 years age group compared to other groups (p = 0.000) and the stones were mostly located on the right side in this age group (p = 0.007). There was no significant relationship between age groups and gender, stone localization, and number of SWL sessions. The overall SFR was 66.4%. Although the SFR was lower (61.4%) and the rate of multiple sessions (27.2%) was higher in ≥ 65 years group, there was no statistically significant difference between age groups regarding SFR, CIRF, need for additional sessions, and complication rates.
Conclusions: Due to its similar clinical results, treatment of SWL should not be ignored as a treatment option in the geriatric patient group with kidney stones.
Arch Ital Urol Androl. 2020 Dec 18;92(4). doi: 10.4081/aiua.2020.4.350. PMID: 33348965
Results of SWL were evaluated in three age groups: 18-40, 41-64, and ≥65 years. Although the purpose of the report was to draw conclusions on SWL in elderly patients, there is no information on the mean age in the ≥65 group, only that the mean (SD) age in all patients was 47(13) years. In average 78.1% of the patients were satisfactorily treated with ONE session and the corresponding figure for ≥65 patients was 72.8; no significant difference. The outcome in the three groups were similar:
All treatments were carried out with Siemens Lithostar Modularis Uro-plus.
The conclusion was that SWL is an especially useful non-invasive treatment for patients with stones up to 20 mm in diameter also for those ≥65 years old. This conclusion is in line with my own experience.
There is one statement in the Discussion that needs to be emphasised: “We think that better pain management can increase the success rate and reduce the complication rate by providing a better focus of the stone”. I cannot but strongly agree with this conclusion. Poor treatment results are in many cases explained by the fact that it has not been possible to complete SWL in an optimal way! Bottomline: Never hesitate to give adequate pain treatment. This does not mean that the patient needs general anaesthesia because satisfactory pain relief can in most cases be accomplished by administration of small intermittent doses of alfentanil and propofol. Note: administration of propofol to old patients should be made with great care and only with as small doses as possible. Sometimes it is recommended to only give alfentanil to these patients!