Efficacy and Safety of Percutaneous Nephrolithotomy in Patients Over 70 Years with Kidney Stones

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 allprocedures 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.