engleski

Complication rate and efficacy of extracorporeal shock wave lithotripsy in elderly patients

Introduction Extracorporeal shockwave lithotripsy (ESWL) is successful method for treatment of urinary calculi with low complication rate in general population. Less favorable outcome was reported in elderly population. The aim of the study was to investigate success and complication rate of ESWL in patients older then 65 years. Patients and methods Study included 292 patients older then 65 years treated by step-wise ESWL (Siemens Lithostar Plus) during the seven year period (2001-2008). The data were retrieved from prospectively collected medical records and analyzed retrospectively. Demographic data, comorbidities, kidney function, stone characteristics, treatment details, complications (pain, bleeding, uretheric obstruction) and stone free rate (SFR) were analyzed. SFR was determined as complete resolution of stone or presence of asymptomatic residual fragments within kidney less then 4 mm in diameter. Descriptive statistical analysis was performed by SPSS statistical program. Results Patients older than 65 years presented 14.1% of the total of 2067 patients treated by ESWL. The mean age of the patients was 70± 5.33 years (max. 84 years), equally for both genders. Patients were treated by the total of 505 ESWL sessions (mean 1.73± 1.19 per patient, max. 8 sessions). The patients received 3166± 569 impulses per session (min. 1000, max. 5000) with mean energy of 2.8± 0.69 SU (SU- Siemens standard unit) with min. 1.0 and max. 5.0. Most common stone site was in kidney pelvis (38.8%), followed by lower calices in 16.4% and distal ureter in 15.3%. Stones were largest in upper calices (19.4± 10.9 mm), kidney pelvis (16.8± 7.46 mm) and lower calices (11.7± 5.71 mm). In 29.8% of patients JJ stent placement was required prior or after the procedure. Ureterorenoscopy or percutaneus lithotripsy were needed in 6.6% of patients in later follow-up. Comorbidity was present in 69.3% of the patients. Arterial hypertension was the most common (22.5%), diabetes mellitus was found in 9.3%, multiple kidney cysts in 9.3% and malignancy in 4.9%. Overall complication rate was 11.4%. Steinstrasse developed in 8 patients, strong pain needing prolonged hospitalization in 6 and renal subcapsular haematoma in 3 patients. Renal haematomas were treated conservatively. Complication rate was related to older age (p<0.002), more treatments (p<0.038), lesser impulses (p<0.023), larger stones (p<0.0001) and location of stones (p<0.008). Stone free rate was 67.2%. Smaller stones (p<0.002), lower creatinine level (p<0.003), older age (p<0.036) and lower ESWL energy (p<0.02) were significant predictors of positive outcome. Conclusion ESWL is safe and feasible method of treatment for urinary stones in elderly patients, but with somewhat lower stone free rate and slightly increased rate of complications, especially hematomas (in our study 1.6%). Lower stone free rate sets a need for additional ESWL treatments. However, no surgical management of any complication was needed. Taken in consideration that alternative methods (URS or PCNL) are surgical procedures requiring anesthesia with known complications in comorbid patients, such rate of complication of ESWL is acceptable.

ESWL; elderly; complications

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