BERKELEY, CA (UroToday.com) - Although there were plenty of literature discussing various factors affecting the clinical outcome of SWL, patients’ age was not mentioned frequently. However, there were still some reports included patient’s age as potential predictor in the multivariate analysis of treatment outcome.^1-6 The conclusions of these reports suggested that patient’s age was a significant outcome predictor for the overall analysis and renal stone subgroup, but not for ureteral stones.

At this moment, we did not know the reason for the poorer outcome of renal calculi in the elderly population. However, this is unlikely related to any change in the composition of the stone, or both renal and ureteral stones should be affected. The other possibility might be related to the effectiveness of the transmission of shock wave energy to the targeted stone. It is well known that aging results in sclerotic change of kidneys. We suspect that this age related sclerosis would cause change in acoustic impedance of the kidneys, which in turn lower the efficacy of shock wave transmission and hence lower fragmentation and stone-free rate of renal stones. However, further studies are needed to confirm our postulation.

References

1. Ikegaya H, Kato A, Kumano S and Tominaga T. Correlation between age and the efficacy of ESWL. BJU int 2005; 96:1145-6.
2. Ackermann DK, Fuhrimann R, Pfluger D, Studer UE and Zingg EJ. Prognosis after extracorporeal shock wave lithotripsy of radioopaque renal calculi; a multivariate analysis. Eur Urol 1994; 25: 105-109.
3. Abe T, Akakura K, Kawaguchi M et al. Outcomes of shockwave lithotripsy for upper urinary tract stones: a large scale study at a single institution. J Endourol 2005; 19: 768-773.
4. Abdel-Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M and Bazeed M. Prediction of success rate after extracorporeal shock wave lithotripsy of renal stones. Scand J Urol Nephrol 2004; 38: 161-167.
5. Gomha MA, Sheir KZ, Showky S, Abdel-Khalek M, Mokhtar AA and Madbouly K. Can we improve the prediction of stone-free status after extracorporeal shock wave lithotripsy for ureteral stones? A neural network or statistical model. J Urol 2004; 172: 175-179.
6. Delakas D, Karyotis I, Daskalopoulos G, Lianos E and Mavromanolakis E. Independent predictors of failure of shockwave lithotripsy for ureteral stones employing a second-generation lithotripter. J Endourol 2003; 17: 201-205.

Written by
Professor Anthony NG Chi-fai MD, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Is Extracorporeal Shock Wave Lithotripsy the Preferred Treatment Option for Elderly Patients with Urinary Stone? A Multivariate Analysis of the Effect of Patient Age on Treatment Outcome - Abstract

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