Stones and Endourology in Older Adults

  • David A. DucheneEmail author
  • Margaret S. Pearle


Urolithiasis is a common medical condition that may affect patients of all age groups. Combining an overall increase in the prevalence of kidney stones and an increasing life-expectancy, we can expect to see an additional number of older individuals with kidney stones. The geriatric patient with urolithiasis may present differently than their younger counterparts, have more medical comorbidities, and need different preoperative, intraoperative, and postoperative care. This chapter is designed to explore the prevalence of urolithiasis in the elderly population, discuss differences in clinical presentation, and outline treatment options and outcomes in the endourological management of older adults.


Kidney Stone Shock Wave Lithotripsy Geriatric Patient Stone Disease Ureteral Stone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Stamatelou KK, Francis ME, Jones CA, et al. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003;63:1817–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Payne CK, Babiarz JW, Raz S. Genitourinary problems in the elderly patient. Surg Clin North Am. 1994;74:401–29.PubMedGoogle Scholar
  3. 3.
    Asper R. Epidemiology and socioeconomic aspects of urolithiasis. Urol Res. 1984;12:1–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Hiatt RA, Dales LG, Friedman GD, et al. Frequency of urolithiasis in a prepaid medical care program. Am J Epidemiol. 1982;115:255–65.PubMedGoogle Scholar
  5. 5.
    Gentle DL, Stoller ML, Bruce JE, et al. Geriatric urolithiasis. J Urol. 1997;158:2221–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Lieske JC, de la Vegas LS, Slezak JM, et al. Renal stone epidemiology in Rochester, Minnesota: an update. Kidney Int. 2006;69:760–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12:e86–96.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Pearle MS, Calhoun EA, Curhan GC, and the Urological Diseases in America Project. Urologic Diseases in America Project: Urolithiasis. J Urol. 2005;173:848–57.PubMedCrossRefGoogle Scholar
  9. 9.
    Scales CD, Smith AC, Hanley JM, Saigal CS, and the Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol. 2012;62:160–5.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Arampatzis S, Lindner G, Irmak F, et al. Geriatric urolithiasis in the emergency department: risk factors of hospitalization and emergency management patterns of acute urolithiasis. BMC Nephrol. 2012;13:117.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Wofford JL, Schwartz E, Timerding BL, et al. Emergency department utilization by the elderly: analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med. 1996;3:694–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Hustey FM, Meldon SW, Banet GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med. 2005;23:259–65.PubMedCrossRefGoogle Scholar
  13. 13.
    Krambeck AE, Lieske JC, Li S, et al. Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population. J Urol. 2013;189:158–64.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Usui Y, Matsuzaki S, Matsushita K, et al. Urolithiasis in geriatric population. J Exp Clin Med. 2003;28:81–7.Google Scholar
  15. 15.
    Neuzillet Y, Lechevallier E, Ballanger P, et al. Urinary stones in subjects over the age of sixty. Prog Urol. 2004;14:479–84.PubMedGoogle Scholar
  16. 16.
    Goldfarb DS, Parks JH, Coe FL. Renal stone disease in older adults. Clin Geriatr Med. 1998;14:367–81.PubMedGoogle Scholar
  17. 17.
    Moesch C, Charmes JP, Gaches F, et al. Crystalluria prevalence in the elderly. Eur J Med. 1993;2:512.PubMedGoogle Scholar
  18. 18.
    Alexander RT, Hemmelgarn BR, Wiebe N, et al. Kidney stones and kidney function loss: a cohort study. BMJ. 2012;345:e5287.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Kerbl K, Rehman J, Landman J, Lee D, Sundaram C, Clayman RV. Current management of urolithiasis: progress or regress? J Endourol. 2002;16:281–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Ackermann DK, Fuhrimann R, Pfluger D, Studer UE, Zingg EJ. Prognosis after extracorporeal shock wave lithotripsy of radiopaque renal calculi: a multivariate analysis. Eur Urol. 1994;25:105–9.PubMedGoogle Scholar
  21. 21.
    Abdel-Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M, Bazeed M. Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones–a multivariate analysis model. Scand J Urol Nephrol. 2004;38:161–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Gomha MA, Sheir KZ, Showky S, Abdel-Khalek M, Mokhtar AA, Madbouly K. Can we improve the prediction of stone-free status after extracorporeal shock wave lithotripsy for ureteral stones? A neural network or a statistical model? J Urol. 2004;172:175–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Ng CF, Wong A, Tolley D. Is extracorporeal shock wave lithotripsy the preferred treatment option for elderly patients with urinary stone? A multivariate analysis of the effect of patient age on treatment outcome. BJU Int. 2007;100:392–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Wiesenthal JD, Ghiculete D, Ray AA, Honey RJ, Pace KT. A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi. J Urol. 2011;186:556–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Simunovic D, Sudarevic B, Galic J. Extracorporeal shockwave lithotripsy in elderly: impact of age and comorbidity on stone-free rate and complications. J Endourol. 2010;24:1831–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Halachmi S, Meretyk S. Shock wave lithotripsy for ureteral stones in elderly male patients. Aging Male. 2006;9:171–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Sighinolfi MC, Micali S, Grande M, Mofferdin A, De Stefani S, Bianchi G. Extracorporeal shock wave lithotripsy in an elderly population: how to prevent complications and make the treatment safe and effective. J Endourol. 2008;22:2223–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Dhar NB, Thornton J, Karafa MT, Streem SB. A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol. 2004;172:2271–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Knapp R, Frauscher F, Helweg G, et al. Age-related changes in resistive index following extracorporeal shock wave lithotripsy. J Urol. 1995;154:955–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Janetschek G, Frauscher F, Knapp R, Hofle G, Peschel R, Bartsch G. New onset hypertension after extracorporeal shock wave lithotripsy: age related incidence and prediction by intrarenal resistive index. J Urol. 1997;158:346–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Stoller ML, Bolton D, St Lezin M, Lawrence M. Percutaneous nephrolithotomy in the elderly. Urology. 1994;44:651–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Dore B, Conort P, Irani J, et al. Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70: a multicentre retrospective study of 210 cases. Prog Urol. 2004;14:1140–5.PubMedGoogle Scholar
  33. 33.
    Sahin A, Atsu N, Erdem E, et al. Percutaneous nephrolithotomy in patients aged 60 years or older. J Endourol. 2001;15:489–91.PubMedCrossRefGoogle Scholar
  34. 34.
    Kuzgunbay B, Turunc T, Yaycioglu O, et al. Percutaneous nephrolithotomy for staghorn kidney stones in elderly patients. Int Urol Nephrol. 2011;43:639–43.PubMedCrossRefGoogle Scholar
  35. 35.
    Karami H, Mazloomfard MM, Golshan A, Rahjoo T, Javanmard B. Does age affect outcomes of percutaneous nephrolithotomy? Urol J. 2010;7:17–21.PubMedGoogle Scholar
  36. 36.
    Anagnostou T, Thompson T, Ng CF, Moussa S, Smith G, Tolley DA. Safety and outcome of percutaneous nephrolithotomy in the elderly: retrospective comparison to a younger patient group. J Endourol. 2008;22:2139–45.PubMedCrossRefGoogle Scholar
  37. 37.
    Yuan H, Zheng S, Liu L, Han P, Wang J, Wei Q. The efficacy and safety of tubeless percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Res. 2011;39:401–10.PubMedCrossRefGoogle Scholar
  38. 38.
    Wang J, Zhao C, Zhang C, Fan X, Lin Y, Jiang Q. Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis. BJU Int. 2012;109:918–24.PubMedCrossRefGoogle Scholar
  39. 39.
    Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tubeless percutaneous nephrolithotomy. J Endourol. 2008;22:267–71.PubMedCrossRefGoogle Scholar
  40. 40.
    Gupta V, Sadasukhi TC, Sharma KK, Yadav RG, Mathur R. Tubeless and stentless percutaneous nephrolithotomy. BJU Int. 2005;95:905–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Aghamir SM, Hosseini SR, Gooran S. Totally tubeless percutaneous nephrolithotomy. J Endourol. 2004;18:647–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Kara C, Resorlu B, Bayindir M, Unsal A. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology. 2010;76:289–93.PubMedCrossRefGoogle Scholar
  43. 43.
    Resorlu B, Diri A, Atmaca AF, et al. Can we avoid percutaneous nephrolithotomy in high-risk elderly patients using the Charlson comorbidity index? Urology. 2012;79:1042–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Tok A, Ozturk S, Tepeler A, Tefekli AH, Kazancioglu R, Muslumanoglu AY. The effects of percutaneous nephrolithotomy on renal function in geriatric patients in the early postoperative period. Int Urol Nephrol. 2009;41:219–23.PubMedCrossRefGoogle Scholar
  45. 45.
    Chandhoke PS, Albala DM, Clayman RV. Long-term comparison of renal function in patients with solitary kidneys and/or moderate renal insufficiency undergoing extracorporeal shock wave lithotripsy or percutaneous nephrolithotomy. J Urol. 1992;147:1226–30.PubMedGoogle Scholar
  46. 46.
    Cybulski P, Honey RJ, Pace K. Fluid absorption during ureterorenoscopy. J Endourol. 2004;18:739–42.PubMedCrossRefGoogle Scholar
  47. 47.
    Rehman J, Monga M, Landman J, et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61:713–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger GM. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. 2004;18:33–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.University of Kansas Medical CenterKansas CityUSA
  2. 2.UT Southwestern Medical CenterDallasUSA

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