Geriatric Urolithiasis

Gentle, Donald L.; Stoller, Marshall L.; Bruce, Jeremy E.; Leslie, Stephen

doi:10.1016/s0022-5347(01)68203-x

Cited by 63 publications

(55 citation statements)

References 14 publications

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“…New onset urolithiasis in the aging population does not appear to be simply an extension of the disease that is observed in the younger stone forming population, but rather is a disease with unique characteristics. 9,10,14 In this study we confirmed that there are indeed important differences in the presentation and treatment of urolithiasis between younger and older adults.In this community based study, incident stone formers who presented with typical renal colic were significantly younger than patients with atypical pain or no pain at all. Furthermore, older individuals were more likely to present with fever, pyuria and gastrointestinal symptoms.…”

supporting

confidence: 79%

“…Other investigators have noted similar increases in uric acid stone disease in the elderly population with rates ranging from 11% to 31.5%. 9,10,[15][16][17] Conversely, in our study calcium phosphate stone disease was more common in the younger age groups. However, when brushite stones were specifically examined they were more likely to present in older individuals.…”

mentioning

confidence: 71%

“…1,[9][10][11] In this population based study of validated incident symptomatic stone formers, we found that 16% (248 of 1,590) were older than age 60 years. New onset urolithiasis in the aging population does not appear to be simply an extension of the disease that is observed in the younger stone forming population, but rather is a disease with unique characteristics.…”

Section: Discussionmentioning

confidence: 99%

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

Krambeck

Lieske

et al. 2012

Journal of Urology

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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...

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supporting

confidence: 79%

mentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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

Krambeck

Lieske

et al. 2012

Journal of Urology

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“…Metabolic abnormality is common in elderly patients with high incidence of isolated hypocitraturia and previous parathyroidectomy. Most common stone analysis in geriatric patients are calcium oxalate (79%) followed by uric acid (10%), calcium phosphate (5%) and cystine (5%) (8).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of percutaneous nephrolithotomy: Comparison of elderly and younger patients

2013

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Background and purpose: Percutaneous nephrolithotomy (PCnL) in elderly patients is challenging due to the high prevalence of comorbidity and single kidney. We compared the results and complications of patients who were submitted to PCnL according to age (higher than and lower than 65 years old). Materials and Methods: A total of 61 patients aged more than 65 years old (group I) and 385 patients aged 65 years old or less (group II) were treated with PCnL. PCnL was performed by a standard technique under fluoroscopic guidance. The operative time, length of hospital stay, success rate, auxiliary treatment and complications of both groups were compared. Results: Patients older than 65 years old (group I) had more comorbidities mainly diabetes mellitus, hypertension and higher level of ASA classification (P < 0.001). The success rate was 85.24% and 86.24% of groups I and II, respectively. Four patients (6.56%) of group I and 55 patients (14.29%) of group II needed auxiliary treatment (P = 0.098). Among the complications, only sepsis was significantly higher in group I (6.56% of group I and 1.3% of group II, P = 0.007). The operative time, success rate, hospital stay and complications except sepsis episode did not significantly differ between the two groups. Conclusion: Percutaneous nephrolithotomy is effective and safe in elderly patients even though with more comorbidities. Sepsis is the only more frequent common complication following PCnL in elderly.

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“…In a study of 5,942 geriatric (age greater than 65 years) stone formers, the rate of finding no metabolic abnormalities was more than 35%. 17 In a separate analysis of 1,392 stone formers, after excluding low urine volume in 23% and infection in 2.5% as causes for stone formation, 1.1% had no metabolic abnormality identified. 18 Curhan et al found that specifically among nonstone formers, the rates of hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitruria and low urine volume were 14% to 27%, 7% to 43%, 8% to 40%, 3% to 9% and 7% to 20% among 3 prospective cohorts of health professionals, respectively.…”

Section: Drawbacksmentioning

confidence: 94%

The Role of the 24-Hour Urine Collection in the Prevention of Kidney Stone Recurrence

et al. 2017

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Purpose: Kidney stone prevention relies on the 24-hour urine collection to diagnose metabolic abnormalities and direct dietary and pharmacological therapy. While its use is guideline supported for high risk and interested patients, evidence that the test can accurately predict recurrence or treatment response is limited. We sought to critically reassess the role of the 24-hour urine collection in stone prevention. Materials and Methods: In addition to a MEDLINEÒ search to identify controlled studies of dietary and pharmacological interventions, evidence supporting the AUA (American Urological Association) and EAU (European Association of Urology) guidelines for metabolic stone prevention were evaluated. Additionally, the placebo arms of these studies were examined to assess the stone clinic effect, that is the impact of regular office visits without specific treatment on stone recurrence. Results: The 24-hour urine test has several limitations, including the complexity of interpretation, the need for repeat collections, the inability to predict stone recurrence with individual parameters and supersaturation values, the unclear rationale of laboratory cutoff values and the difficulty of determining collection adequacy. Only 1 prospective trial has compared selective dietary recommendations based on 24-hour urine collection results vs general dietary instructions. While the trial supported the intervention arm, significant limitations to the study were found. Placebo arms of intervention trials have noted a 0% to 61% decrease in stone recurrence rate and a remission rate during the study of 20% to 86%. Conclusions: Whether all recurrent stone formers benefit from 24-hour urine collection has not been established. Additional comparative effectiveness trials are needed to determine which stone former benefits from selective therapy, as guided by the 24-hour urine collection.

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Geriatric Urolithiasis

Cited by 63 publications

References 14 publications

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

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

Outcomes of percutaneous nephrolithotomy: Comparison of elderly and younger patients

The Role of the 24-Hour Urine Collection in the Prevention of Kidney Stone Recurrence

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