Comparison and Evaluation of Outcomes of Ureteroscopy and Stone Laser Fragmentation in Extremes of Age Groups (≤10 Years and ≥80 Years of Age): A Retrospective Comparative Analysis of over 15 Years from 2 Tertiary European Centres

Abstract

Aim: To assess and compare the outcomes associated with ureteroscopy and laser fragmentation (URSL) for extremes of age group (≤10 and ≥80 years). Methods: Retrospective consecutive data were collected from two European centres for all paediatric patients ≤10 undergoing URSL over a 15-year period (group 1). It was compared to consecutive data for all patients ≥80 years (group 2). Data were collected for patient demographics, stone characteristics, operative details, and clinical outcomes. Results: A total of 168 patients had 201 URSL procedures during this time (74 and 94 patients in groups 1 and 2 respectively). The mean age and stone sizes were 6.1 years and 85 years, and 9.7 mm and 13 mm for groups 1 and 2 respectively. While the SFR was slightly higher in group 2 (92.5% versus 87.8%, p = 0.301), post-operative stent rate was also significantly higher in the geriatric population (75.9% versus 41.2%, p = 0.0001). There was also no significant difference in pre-operative stenting (p = 0.886), ureteric access sheath use (UAS) (p = 0.220) and post-operative complications. Group 1 had an intervention rate of 1.3/patient as compared to 1.1/patient in group 2. The overall complications were 7.2% and 15.3% in groups 1 and 2 respectively (0.069), with 1 Clavien IV complication related to post-operative sepsis and brief ICU admission in group 2. Conclusion: The paediatric population had a marginally higher incidence of repeat procedure, but the overall SFR and complications were similar, and post-operative stent insertion rates were much better compared to geriatric patients. URSL is a safe procedure in the extremes of age groups with no difference in the overall outcomes between the two groups.

Is ureteroscopy and active stone treatment safe and effective in octogenarians? A review of current literature

“…Our literature review finds that URS is safe and efficacious for the octogenarian cohort. The SFR and complication rates are comparable and not dissimilar from other younger age group, as particularly described by Sinha [ 19 ] and Tamiya [ 20 ]. Comparing URS data in the elderly population and in the young (<65 years old) or very young paediatric population (<10 years), both of the studies found that surgical complication rate and successful events were similar in the different age groups.…”

“…The sample size ranged from 27 to 338 across 10 studies, with a mean age of studies between 81 and 89 years, with the cut-off for the lower end being 80 years. Eight of these studies focused on URS independently [ 6 , 13–16 , 19–21 ] and the other two discussed URS in conjunction with SWL [ 17 , 18 ], under a common description of ‘active stone treatment’, rendering some of the data unsuitable for inclusion in certain categories, where data could not be retrieved separately.…”

“…Only 4 studies [ 13 , 15 , 17 , 18 ] commented on the Performance Status (PS), with 29.6% PS of 0 or 1, 32.5% PS of 2 or 3 and 37.9% PS of 4. Apart from one study [ 19 ], all other studies collected ASA scores. The ASA score of 1 was seen in 1.85%, 2 in 43.05% and 3 or more in 55.14%.…”

Minimally Invasive Urological Procedures and Related Technological Developments—Series 2

“…Lasers have evolved with the advent of high-power holmium lasers, thulium fiber laser (TFL), and pulse modulation such as Moses technology [3][4][5]. There are four papers involving the use of lasers in endourology [6][7][8][9][10]. Laser efficiency and safety were compared between Holmium YAG and TFL lasers, with the latter showing higher efficiency [6].…”

“…Laser efficiency and safety were compared between Holmium YAG and TFL lasers, with the latter showing higher efficiency [6]. Laser lithotripsy during ureteroscopy and stone fragmentation with comparative outcomes between ≤10 years and ≥80 years were examined by the second paper [7]. The results showed that while the former group had a higher incidence of repeated procedure, there was no difference in the overall stone-free rate (SFR) and complications between the groups.…”