Golomb Dor, Shemesh Amit, Goldberg Hanan, Shalom Ben, Hen Eyal, Barkai Eyal, Atamna Fahed, Abu Nijmeh Haitham, Cooper Amir, Raz Orit
Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
Department of Urology, State University of New York, Upstate Medical University, Syracuse, NY, USA.
Urologia. 2023 Feb;90(1):36-41. doi: 10.1177/03915603221116992. Epub 2022 Aug 16.
To examine the age-related differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones.
A retrospective analysis of all patients who visited the ED at a single institution that were found to have a ureteral stone on CT. Clinical, laboratory, and imaging parameters were collected, including outcomes. Patients were subdivided into age groups: 18-30, 31-50, 51-70, and >70 years.
Between January 2018 and December 2020, 778 patients were admitted to the ED with a ureteral stone. About 78% (609) were males and 22% (169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively ( = 0.08). Patients in the 36-50 age group, had significantly higher visual analogue scale (VAS) scores ( < 0.0001). Patients older than 70 years old presented with significantly higher serum creatinine levels ( < 0.0001), C-reactive protein (CRP) ( < 0.001) and leukocyte levels ( = 0.002). These patients were also found to have significantly larger stones (mean size of 6.2 mm (SD 4.8) ( < 0.0001)) and underwent percutaneous nephrolithotripsy (PCNL) in significantly higher numbers (56.3% vs 43.8%, ( < 0.0001)). Less than half of the patients older than 50 years were given medical expulsive therapy (MET) with alpha-blockers, compared to more than 50% in the other age groups ( = 0.002). Spontaneous stone expulsion was noted in 70.2% of the 18-35-year group, 62.4% of the 36-50-year-old group, 51.8% of the 51-70-year-old group, and 37% of the >70-year-old group ( < 0.0001). The ED re-admission rates at 7 and 30 days were not significantly different among all age groups.
Our data suggests that older patients presented with larger stones, elevated inflammatory markers and creatinine and were more likely to require surgical intervention. The spontaneous stone expulsion rate was inversely associated with age.
研究因输尿管结石入院急诊科（ED）患者在表现、治疗及结局方面的年龄差异。
对在单一机构急诊科就诊且CT检查发现输尿管结石的所有患者进行回顾性分析。收集临床、实验室及影像参数，包括结局。患者被分为年龄组：18 - 30岁、31 - 50岁、51 - 70岁及>70岁。
2018年1月至2020年12月期间，778例因输尿管结石入院急诊科。约78%（609例）为男性，22%（169例）为女性。男性和女性的平均年龄分别为49.4（标准差14.4）和51.6（标准差15.7）（P = 0.08）。36 - 50岁年龄组患者的视觉模拟评分（VAS）显著更高（P < 0.0001）。70岁以上患者的血清肌酐水平（P < 0.0001）、C反应蛋白（CRP）（P < 0.001）和白细胞水平显著更高（P = 0.002）。还发现这些患者的结石明显更大（平均大小为6.2mm（标准差4.8）（P < 0.0001）），接受经皮肾镜取石术（PCNL）的比例显著更高（56.3%对43.8%，（P < 0.0001））。50岁以上患者中不到一半接受α受体阻滞剂药物排石治疗（MET），而其他年龄组超过50%（P = 0.002）。18 - 35岁组70.2%、36 - 50岁组62.4%、51 - 70岁组51.8%及>70岁组37%的患者结石自行排出（P < 0.0001）。所有年龄组7天和30天的急诊科再入院率无显著差异。
我们的数据表明，老年患者结石更大，炎症标志物和肌酐升高，更可能需要手术干预。结石自行排出率与年龄呈负相关。
