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Management of large kidney stones in the geriatric population

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Abstract

Purpose

The aim of this review is to highlight the unique factors that predispose geriatric patients to nephrolithiasis and to compare the utility and efficacy of surgical techniques in this specific patient population.

Methods

PubMed and EMBASE databases were reviewed, and studies were organized according to surgical treatments.

Results

Few prospective studies exist comparing kidney stone removal in the elderly to younger cohorts. In addition, various age cut-offs were used to determine who was considered elderly. Most studies which analyzed Percutaneous Nephrolithotomy (PCNL) found a slightly higher rate of minor complications but comparable stone free rate and operative time. For ureteroscopy (URS) and extracorporeal shockwave lithotripsy (ESWL), there were minimal complications observed and no difference in clinical success in the elderly. All surgical techniques were presumed to be safe in the elderly and most found no difference in stone-free rates.

Conclusions

Unique attributes of the geriatric population contribute to stone formation and must be considered when determining appropriate management modalities. This review provides an overview of the utility and efficacy of PCNL, URS and ESWL in the elderly, as well as a porposed algorithm for management in this population.

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Authors and Affiliations

  1. Albert Einstein College of Medicine, Bronx, NY, 10461, USA

    Alison E. Schulz & Benjamin W. Green

  2. Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA

    Kavita Gupta, Rutul D. Patel, Justin Loloi, Dima Raskolnikov, Kara L. Watts & Alexander C. Small

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  1. Alison E. Schulz
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Schulz, A.E., Green, B.W., Gupta, K. et al. Management of large kidney stones in the geriatric population. World J Urol 41, 981–992 (2023). https://doi.org/10.1007/s00345-023-04333-y

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  • DOI: https://doi.org/10.1007/s00345-023-04333-y

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