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.
OBJECTIVE
To investigate the effect of patient age on the stone-free rate (SFR) in patients with urinary calculi treated by extracorporeal shockwave lithotripsy (ESWL).


METHODS
In all, 2192 solitary radio-opaque urinary stones of 5-15 mm were identified in adult patients receiving primary ESWL. Patients were divided into three age groups, i.e. < or = 40, 41-60 and >60 years (579, 1026 and 587 patients, respectively). Multiple logistic regression was used to assess the effect of age and other possible predicting factors (gender, stone characteristics, e.g. side, site and size, and the type of lithotripter used) on the SFR at 3 months after treatment.


RESULTS
The overall adjusted odds ratios (95% confidence interval) for the SFR for those aged 41-60 and >60 years (taking those aged < or= 40 years as the reference) were 0.708 (0.573-0.875; P = 0.001) and 0.643 (0.506-0.818; P < 0.001). However, if the patients were divided into those with renal or ureteric stones, only the SFR of the former was affected by age, and the adjusted odds ratios were 0.665 (0.512-0.864; P = 0.002) and 0.629 (0.470-0.841; P = 0.002), respectively. Ageing had no effect on the SFR for ureteric stones.


CONCLUSIONS
The SFR after ESWL for renal stones, but not ureteric stones, was significantly lower in older patients. Further studies on the effects of ageing on renal stone clearance after ESWL are needed to improve stone management in the elderly population.
Ng
Chi-Fai
CF
The Chinese University of Hong Kong, Hong Kong, PRC. ngcf@surgery.cuhk.edu.hk
Wong
Annie
A
Tolley
David
D
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*