Percutaneous Nephrolithotomy in the 80 Years of Age and Older Population.

To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals.

From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999-2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes.

Of the 1,647 patients, median age was 46, 66 and 83 respectively (p<0.0001). 3 patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (p=0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (p=0.06). Mean pre-operative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, p<.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; p=0.02) and transfusions (2.3, 4.7, 10.2%; p<0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted.

PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long term survival.

Urology. 2019 Sep 16 [Epub ahead of print]

Zain A Abedali, Tim Large, Joshua M Heiman, Elhaam Bandali, Blake B Anderson, James E Lingeman, Amy E Krambeck

Department of Urology; Indiana University/IU Health Physicians, Indianapolis, IN., Department of Urology; Indiana University/IU Health Physicians, Indianapolis, IN. Electronic address: .