2243 Effect of Age on the Clinical Presentation of Incident Symptomatic Urolithiasis in the General Population

Abstract

Purpose-We characterized variation in the clinical presentation between older and younger first time symptomatic stone formers in the general population.Materials and Methods-We studied a random sample of Olmsted County, Minnesota residents with their first diagnostic code for urolithiasis between 1984 and 2003. Chart validated symptomatic stone formers had a confirmed stone by imaging or stone passage. Clinical presentation characteristics were compared between age groups.Results-Among the 3,473 charts reviewed there were 1,590 validated incident symptomatic stone formers (mean age 43 years, range 18 to 96). Older individuals were more likely to present with atypical or no pain, fever, diarrhea, pyuria, urinary tract infections and bacteremia (p <0.001). Stone size and location did not differ by patient age. Calcium phosphate stone disease was associated with younger age, while uric acid stone and atypical stone composition was associated with older age (p <0.001). Older individuals were less likely to pass the stone spontaneously and were more likely to require surgical intervention (p <0.001). Surgical intervention was required in 516 (32.5%) individuals. Younger individuals were more likely to undergo ureteroscopy while older individuals were more likely to undergo shock wave lithotripsy, temporizing stent placement and percutaneous nephrolithotomy.Conclusions-The detection of stone disease in older individuals can be challenging due to atypical pain or absence of pain, as well as the presence of other comorbid conditions such as urinary tract infections and diarrhea. A higher index of suspicion for urolithiasis may be needed in the elderly for a more timely diagnosis and intervention to prevent morbidity. Keywords urolithiasis; age factors; epidemiology; urinary tract infections Urolithiasis is a common disorder affecting all age groups. Studies from the United States and other countries indicate that the incidence of upper tract stone disease has increased steadily during the last 5 decades. [1][2][3][4][5] With improvements in medical care and overall life expectancy, stone disease could become more common in the geriatric population. However, little is known about the effect of age on urolithiasis and existing data on geriatric stone disease are inconsistent. Payne et al found that urinary stone disease was more likely to Population based studies confirm an increase in urinary stone disease in the elderly. The NHANES II (National Health and Nutrition Examination Survey) showed increasing rates of stone disease in men up to age 65 years and in women to age 70 years. 11 A population based epidemiological study focusing on Olmsted County, Minnesota found that incident stone disease peaked for men age 60 to 69 years, and 2 peaks were noted for women at ages 30 to 39 and 60 to 69 years. 1 Finally, another study focusing on Wisconsin residents showed an increase in stone incidence in the age 60 to 64 and age 80 to 84 cohorts. 5 Given this evidence that stone disease has a significant impact on the agin...