Extracorporeal Shock Wave Lithotripsy in an Elderly Population: How to Prevent Complications and Make the Treatment Safe and Effective

Sighinolfi, Maria Chiara; Micali, Salvatore; Grande, M.; Mofferdin, A.; Stefani, Stefano De; Bianchi, Giampaolo

doi:10.1089/end.2008.9704

Cited by 33 publications

(31 citation statements)

References 21 publications

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“…Early reports regarding the use of SWL in this patient group have considered the method as safe and effective [5], and these results have been reproduced by more recent papers [6,7]. However, the issue of the method's efficacy (particularly in terms of stone-free rates, SFR) has not been clarified.…”

Section: Discussionmentioning

confidence: 99%

“…Issues of relevance for this population have been identified in the past and contribute to the notion that geriatric stone patients should not be considered a mere extension of the younger lithiasis population [3,4]. Previous studies focusing on the effect of age on the success rates of SWL have led to conflicting results [5][6][7][8][9][10][11], and the issue of SWL efficacy in the elderly stone population remains to be clarified.…”

Section: Introductionmentioning

confidence: 99%

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Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis

et al. 2011

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The aim of the study was to evaluate the impact of age on the efficacy of extracorporeal shock wave lithotripsy (SWL), in a comparative study based on the principles of matched-pair analysis. Over a period of 4 years, 2,311 patients were treated with SWL in a tertiary referral center. Patient and stone data were recorded in a prospective electronic database. Among these patients, 115 (4.97%) were older than 70 years of age and fulfilled the criteria for inclusion in the study (Group A). For the purposes of the comparative analysis, Group A patients were matched for gender and stone parameters (side, location of stone, and diameter ±2 mm) with a control group of patients under the age of 70 (Group B). Following matching, the patients' electronic medical records were reviewed, to identify SWL success rates at 3 months and McNemar's test was used to compare the efficacy of SWL between the two groups. Matching was possible in all cases. The results indicate that there were no statistically significant differences in the mean number of SWL sessions or in the mean number of impulses per session between the two groups. The overall stone clearance rate achieved by SWL alone was 71.3% for Group A and 73.9% for group B. Discordant pairs were found in 37 cases (in 17 pairs only patients in Group A became stone-free, while in 20 pairs only patients in Group B became stone-free). By using McNemar's test, the difference in stone clearance rates between the two groups was not found to be statistically significant (p = 0.742). A total of 22 patients (19.1%) in Group A and 17 patients (14.7%) in Group B underwent an adjuvant procedure to achieve stone clearance. McNemar's test also revealed the absence of any statistically significant difference in SWL success rates between older and younger patients in the subgroups of patients presenting with either ureteric or renal stones (p = 0.727 and p = 0.571, respectively). In conclusion, SWL is still considered one of the first-line tools for geriatric patients suffering from urolithiasis, as increased age alone does not seem to adversely affect the efficacy of SWL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis

et al. 2011

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“…Depending on the studied population, age limit, number of treatments needed, the definition (complete resolution or presence of clinically insignificant residual fragments), and time of SFR assessment, the SFRs in elderly ranged from 37.6% 4 to 87.1%. 5 Here we set to determine whether success of SWL in treating urolithiasis in older patients depends on age alone and to compare the complication rates between the studied age groups. Our hypothesis was that SFRs and number of complications do not depend on age of the treated patient and that good results with low morbidity could be accomplished with well-selected patients.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Alternative stone removal procedures, such as ureterorenoscopy (URS) or percutaneous nephrolithotripsy (PCNL), are generally associated with greater morbidity because they require regional or general anesthesia and thus, in most cases, are not feasible as the first-line treatment option for elderly patients, because of their comorbidities and polypragmasia. However, if stone disintegration is not achieved by initial session, SWL sets a need for repeated treatments and thus increases the risk of complications in comorbid patients.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Shockwave Lithotripsy in Elderly: Impact of Age and Comorbidity on Stone-Free Rate and Complications

Šimunović

Sudarević

Galić

2010

Journal of Endourology

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“…45,46 Among the elderly, ESWL has proven to be an effective method, achieving up to 78% of patients free from calculi and with no additional complications related to age. 47 Also with the aim of improving results, technical changes are being introduced to the method of administration; some of the most cited are the reduction in the number of impulses from 120 to 60 per minute and the use of increasing power rather than steady power during administration. 47,48,49 Currently, the indications for ESWL are treatment of non-obese patients (BMI < 30 or weight < 120 kg), patients with pelvic calculi and calculi of the upper or mid poles< 2 cm or lower pole calculi < 1 cm, with a CT-measured density of less than 1000UH and a skin-calculus distance of less than 10 cm.…”

Section: Resultsmentioning

confidence: 99%

O que há de novo no diagnóstico e tratamento da litíase urinária?

Mazzucchi¹,

Srougi²

2009

Rev. Assoc. Med. Bras.

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Objective. To review developments in the diagnosis and treatment of urinary lithiasis. MethOds. A review of the most important articles on the subject published in Medline indexed periodicals between 1979 and 2009. Results. Stones occur with greater frequency among people with BMI > 30. Computerized tomography without contrast provides the correct diagnosis in up to 98% of cases. Alpha-adrenergic blockers increase elimination of ureteral calculi smaller than 8 mm by 29%. The proportion of patients free from calculi after ESWL varies from 35% to 91%, depending on size and location. In between 60% and 100% of cases, renal calculi larger than 2 cm are eliminated with PCNL. Calculi of the distal ureter are successfully treated in up to 94% of cases using semi-rigid ureteroscopy, compared to 74% using ESWL. For calculi of the upper ureter success rates are around 77% and 91% for ureteroscopy and 41% and 82% for ESWL. cOnclusiOn. The association between urinary lithiasis and Diabetes mellitus, is well-established. Computerized tomography without contrast is currently the gold standard for diagnosis of urinary lithiasis. In Brazil, ESWL is the method of choice for treating renal calculi smaller than 2 cm and with tomographic density < 1000 HU, except those of the lower pole, where the ideal limit for treatment is 1 cm. Percutaneous nephrolithotripsy is the best method of treating renal calculi larger than 2 cm and semi-rigid ureteroscopy is the best treatment for calculi of the distal ureter. Flexible ureteroscopy is an option for calculi of the upper ureter and renal calculi smaller than 1.5 cm that do not respond to ESWL or where PCNL is contraindicated.

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Extracorporeal Shock Wave Lithotripsy in an Elderly Population: How to Prevent Complications and Make the Treatment Safe and Effective

Abstract: SWL represents the treatment of choice for urolithiasis, and it has to be recommended especially to geriatric patients. In those subjects, SWL complications can be avoided with a proper and personalized preparation, together with an ECG and ultrasound continuously monitored procedure.

Cited by 33 publications

References 21 publications

Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis

Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis

Extracorporeal Shockwave Lithotripsy in Elderly: Impact of Age and Comorbidity on Stone-Free Rate and Complications

O que há de novo no diagnóstico e tratamento da litíase urinária?

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