Clinical presentation of urolithiasis in older and younger population

Abstract

Aim of the study: We compared stone size, localization, complaint at the time of applying, comorbidity, treatment and complications between older (60 years of age and older) and younger patients with urolithiasis (59 years of age and younger). Materials and Methods: We retrospectively reviewed the records of 950 consecutive patients who presented to our clinic and underwent surgery for urolithiasis from January 2007 to March 2012. The patients were divided into two groups: patients ≥ 60 years an patients < 60 years. Results: There were 174 men and 61 women in elderly group, 528 men and 187 women in younger group. Ureteral stones were found more often in the younger group compared to elderly patients (p < 0.05). Conversely, bladder stone was more frequent in the elderly group. In the elderly group comorbidities are more frequent (diabetes mellitus, hypertension, ischemic heart disease, congestive heart disease, osteoarthritis and chronic obstructive lung). Patients ≥ 60 years significantly had larger kidney and bladder stones compared the younger, but ureteral stone sizes were not statistically different between the two groups. Older patients had a higher postoperative complication rate than younger patients (16% versus 3%, p < 0.05) although postoperative complications (e.g. urinary retention, cardiac dysrythmia, fever, constipation) were not serious and resolved with medical treatment. The average length of stay in hospital was longer in the elderly group, but the difference was not statistically significant. Conclusions: Elderly patients with urolithiasis usually have larger and more complex stone disease, more comorbidities and atypical presentation. both men and women (3,4). The lifetime recurrence risk is 50% with an estimated time to recurrence < 1 year in 10% of cases, < 5 years in 35 to 50% of cases and < 10 years in 50% or greater (5). Stones along the urinary tract can be located in the kidneys, ureters and urinary bladder. While approximately 90% of stones are successfully passed out of the urinary tract, the remaining stones generally have to be surgically removed by ureteroscopy or percutaneous nephrolithotomy or comminuted by non-invasive shock wave lithotripsy (6). Stone occurrence is relatively uncommon before age 20 but peaks in incidence in the fourth to sixth decades of life. Geriatric stone formers comprise 10%-12% of all stone formers and may have a proclivity to develop stones due to metabolic changes associated with ageing (7, 8). Altough it has been shown that geriatric patients with stones tend to have their first episode after age 50, it is not well described how the presentation of stones differs in elderly patients (7). According to the World Health Organization (WHO), ageing is defined as living beyond 60 years in a developing country or 65 years in a developed country. The number of ageing people is increasing faster than is any other age group; in 2025, there will be an estimated 1.2 billion individuals over the age of 60, and this number could reach 2 billion by 2050 (9). So, we ...

Epidemiology of paediatric renal stone disease: a 22-year single centre experience in the UK

“…Adult patients are more likely to present with the classic signs and symptoms of urolithiasis, such as flank or abdominal pain and gross haematuria [31]. This symptom may go unrecognised in younger paediatric patients, who may find it difficult to localise or describe their symptoms.…”

Trastornos metabólicos renales en pacientes urolitiásicos cubanos mayores de 60 años

“…Los pacientes mayores de 60 años son un grupo poblacional que experimenta un notorio crecimiento a escala planetaria y tiene más presentaciones atípicas y peor evolución de las urolitiasis que los individuos más jóvenes 5,15,16 . Por consiguiente, las acciones preventivas para las urolitiasis, tanto primarias como secundarias, cobran particular importancia en estos individuos 14 .…”

Correlative Analysis Between Severity of Urolithiasis and Laboratory Parameters and Its Implication in Evaluation of the Probable Risk Profile

“…Some authors indicated that magnesium can lower the risk of stone formation by diverse mechanisms. Magnesium chelates urinary oxalate, producing a soluble magnesium-oxalate complex than calcium oxalate and thus increases urinary citrate level [23]. A low urinary magnesium level has been seen in calcium stone formers with hypercalciuria.…”