Tag Archives: renal stones

The Impact of Comorbidities on the Efficacy of Percutaneous Nephrolitotomy (PCNL) in Elderly Patients

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

University of Medicine and Pharmacy Tirgu Mures, Clinic of Urology

DOI: 10.1515/amma-2016-0025

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.

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

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

University of Medicine and Pharmacy Tirgu Mures, Romania, Clinic of Urology

DOI: 10.1515/amma-2016-0024

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.

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Obesity and Calcium Oxalate Renal Stones

Nicola Th1, Dobreanu Minodora2, Buda Brîndușa3, Oșan V4, Gliga Florina3, Satan Edit1

1 Department of Laboratory Medicine, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Laboratory Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Urology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Kidney stones are a major cause of morbidity. The lifetime prevalence of symptomatic renal stones is approximately 10% in men and 5% in women. The rate of backsliding for calcium oxalate stones is 10% in one year, 30% in 5 years and 50% in 10 years. Urine pH is one of the important factors for urinary stone formation.
Material and methods: We studied 283 renal stone formers (131 men, 152 female), divided according to their BMI (body mass index) in normal body weight (BMI <25 kg/m2), overweight (BMI 25–30 kg/m2) and obese (BMI >30 kg/m2).
Results: Urine pH is inversely related to BMI among patients with urolithiasis (higher BMI will have lower urine pH). The mean urine pH of the normal body weight, overweight, and obese groups was 6.1, 5.5 and respectively 5.7 (p <0.0001).
Conclusions: Obesity is associated with both hypercalciuria and with proteinuria, demonstrated factors in the etiology of urolithiasis, and urinary pH is inversely related to BMI in patients with urinary stones.

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