WCE 2017: Urolithiasis in the Elderly: Protocol Driven Care and Outcomes

Vancouver, Canada (UroToday.com) Mr. Aakash Pai discussed the association of the prevalence of urolithiasis with aging. Thus, urologists often have patients with a higher average age needing assistance with their management of urinary calculi. This specific population usually has co-morbidities, polypharmacy, immobility, and cognitive decline, leading to greater anaesthetic and surgical risks. Mr. Pai therefore aimed to establish standard outcomes from interventions and discover the impact of frailty upon interventions in elderly patients. 

Anaesthetic considerations were taken into account due to the complexity of drug interactions in those of old age. Therefore, preoperative assessment for anesthesia was necessary. The assessment included co-morbidities, functional status, and sensorium using the National Surgical Quality Improvement Programme Frailty Index (NSQIP-FI). 

Mr. Pai and colleagues retrospectively reviewed data from patients (n = 59, mean = 84.6 years) over the age of 80 who required interventions for stone disease between August 2010 and March 2017. Logistic regression analysis was used to evaluate the correlation between complications and predictive factors. 

Data analysis showed that 35% of patients presented with infected obstructed urinary system as the most common symptom. Among those patients, 31% required intensive care admission during their initial presentation. 32% of patients presented with renal colic. The remaining patients had other presentations such as non-specific abdominal pain and confusion that led to general delay in treatment. In terms of frailty index, there was a positive association between NSQIP-FI and risk of intensive care requirement. 

In terms of interventions, 50 patients had ureterorenoscopy, three patients had PCNL, one patient had lithotripsy, and three patients only had stent management. The overall stone free rate was 90%. Median length of stay after the procedures was one day, and there was no complication above Clavien Grade 2. Only one patient required hospital admission due to a cardiac complication. 

Mr. Pai concluded that octogenarians had atypical characteristics in urolithiasis, and so required more intensive care with the presentation of infection. It was important to assess frailty in elderly patients to ensure the correct decision to treat and treatment modality. Among appropriately accessed elderly patients, the stone free rates were excellent, and major complication rates were minimal.              

Presented by: Aakash Pai 

Authors: Aakash Pai, Sarosh Janardanan, Holly Ni Raghallaigh, Philip James, Ravi Kulkarni 
Affiliation: Department of Urology, Ashford and St. Peter’s Hospital, Surrey, England

Written by Long Hoang, Department of Urology, University of California-Irvine at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.