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Outcomes of retrograde intrarenal surgery in elderly patients

By Boris

Volume 9, Issue 1

Original Article / Published: November 2021

DOI: https://www.doi.org/10.57045/jemis/911121.pp43-49

P. Petrov, S. Hristoforov, O. Gatsev, K. Petkova, I. Saltirov

Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgariа

Abstract

Introduction: The development of medical technology, and the improvement of flexible endoscopes and laser lithotripsy devices have led to an expansion of the indications for retrograde intrarenal surgery (RIRS) in the treatment of kidney stones. RIRS has an increased efficacy compared to extracorporeal shockwave lithotripsy (ESWL) and a lower complication rate compared to percutaneous nephrolithotomy (PCNL). With the increase in the world’s population and age, the share of older people is increasing, especially in Western countries. The aim of this study is to compare the efficacy and safety of RIRS in patients aged ≥ 65 years with those < 65 years. Material and methods: A retrospective study of 240 consecutive patients who underwent retrograde intrarenal surgery for renal stones, was performed. Patients were treated at the Clinic of Endourology and SWL of Military Medical Academy, Sofia, for a period from January 2019 to March 2021. 206 patients were <65 years old (group I) and 34 patients were ≥ 65 years (group II). Preoperative characteristics, stone-free rates, operating times, rate of intra- and postoperative complications and rate of auxiliary procedures were compared. Results: Patients’ preoperative characteristics were comparable between groups, except for the preoperative anticoagulation therapy (6.3% for group I and 52.9% for group II; р<0.001) and the higher rate of preoperative renal insufficiency in group II (14,7% vs 8,3%; p=0.022). The majority of patients in group I had an ASA score I – 65.5% and the majority of patients in group II were classified as ASA score III – 52,9% (р<0.001). The predominant comorbidity in group I was hypertension – 19.9% and 63.1% of the patients had no comorbidities. In group II 26.5% of the patients had diabetes and hypertension, and 5.9% had no comorbidities (p<0.001). 47.6% of the patients in group I had Charlson comorbidity index CCI=0 and 35.9% had CCI >2 compared to CCI=0 in 8,8% and CCI>2 in 88.2% of group II (р<0.001). Stone-free rate after a single procedure was 90.8% and 85.3% for groups I and II, respectively, (р=0.032). There were no statistically significant differences in mean operating times, type and severity of complications and mean hospital stay between the two groups. Postoperative fever rate was similar between groups (3.4% vs 5.9%, р=0.480).Conclusion: The results of this retrospective study suggest that RIRS is an appropriate, safe and effective method for the minimally invasive treatment of renal stones in patients aged ≥65 years. Age itself should not be considered a risk factor for postoperative complications.

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How to cite this article:

P. Petrov, S. Hristoforov, O. Gatsev, K. Petkova, I. Saltirov. Outcomes of retrograde intrarenal surgery in elderly patients. Journal of Endourology and Minimally Invasive Surgery 2021; 9 (1): 43-49Как

Corresponding author:

Dr Petar Petrov

Military Medical Academy of Sofia Department of Urology and Nephrology

Sofia 1606, 3 “Georgi Sofiiski” blvd., Bulgaria

E-mail: p.r.petrov7@gmail.com