McCarthy John-Paul, Skinner Thomas A A, Norman Richard W
Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Urol. 2011 Jun;18(3):5717-20.
Urolithiasis is an increasing problem in patients ≥ 80 years. Our objective was to compare patients ≥ 80 years with urolithiasis to a younger cohort in terms of presentation and management.
Patients referred to a tertiary care stone clinic for management of urolithiasis over a 5 year period were reviewed. Data collected on clinical parameters for patients ≥ 80 years were compared with a random sample of those < 80 years.
There were 26 patients ≥ 80 years and 102 in the sample < 80 years; mean age was 83.5 ± 0.6 and 50.1 ± 1.3 years, respectively. The older group had more comorbidities. The presenting complaint was more often flank pain in younger patients. Patients ≥ 80 years had larger stones. Early ureteric stent insertion was more likely in the elderly compared with the younger group (27% versus 7%, p < 0.01). Definitive therapy for patients ≥ 80 years was most often percutaneous nephrolithotomy (PCNL) (23%) compared with only 9% in the younger group. In contrast, the most common definitive treatment modality used for patients < 80 years was extracorporeal shock wave lithotripsy (ESWL) (35% versus 8%, p < 0.01). There was no difference in intraoperative complications. Thirty nine percent of the older group was managed as outpatients. More of the older group had postoperative complications but all were minor.
Urolithiasis in the elderly is challenging to treat because they have more comorbidities and are less likely to present with classic symptoms of renal colic. This may lead to later presentation with larger and more complex stone disease. Early ureteric stent is often required and definitive PCNL is more likely than in the younger cohort. Despite these issues most can be treated safely and often as an outpatient.
尿石症在80岁及以上患者中是一个日益严重的问题。我们的目的是比较80岁及以上尿石症患者与年轻队列在临床表现和治疗方面的差异。
回顾了在5年期间转诊至三级护理结石诊所接受尿石症治疗的患者。将收集的80岁及以上患者的临床参数数据与年龄小于80岁的随机样本进行比较。
80岁及以上患者有26例，年龄小于80岁的样本有102例；平均年龄分别为83.5±0.6岁和50.1±1.3岁。老年组合并症更多。年轻患者中，主要症状更常为胁腹疼痛。80岁及以上患者的结石更大。与年轻组相比，老年患者更常早期插入输尿管支架（27%对7%，p<0.01）。80岁及以上患者最常用的确定性治疗方法是经皮肾镜取石术（PCNL）（23%），而年轻组仅为9%。相比之下，80岁以下患者最常用的确定性治疗方式是体外冲击波碎石术（ESWL）（35%对8%，p<0.01）。术中并发症无差异。老年组39%作为门诊患者治疗。老年组术后并发症更多，但均为轻微并发症。
老年尿石症治疗具有挑战性，因为他们合并症更多，且出现肾绞痛典型症状的可能性较小。这可能导致就诊时结石更大、病情更复杂。通常需要早期插入输尿管支架，且与年轻队列相比，更有可能采用确定性PCNL治疗。尽管存在这些问题，但大多数患者可以安全治疗，且通常可作为门诊患者。
