Pereutaneous Nephrolithotomy in Elderly Patients with Renal Calculi

Objective: To explore the safety and efficacy of percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi in elderly patients. Methods: Totally 57 elderly patients (mean age 69 years, ranged from 61 to 87 years) with renal calculi were treated by PCNL in our hospital from January 2013 to December 2015. Working tunnels F16-F24 were established under B-ultrasound guidance. EMS or holmium laser lithotripsy was used to fragment and remove stones by nephroscopy. Results: The procedure was completed in a mean of 65 min (ranged from 30 to 140 rain), and one-session stone-free rate was 78.9% (45/57). After the procedure, one patient developed fever(>38.5 o C)and then was cured by antibiotics; two patients received blood transfusion(1800 and 2500 ml, respectively)because of massive hemorrhage, and one of them was diagnosed with pseudoaneurysm, and then was cured by selective renal artery embolization. No patient had severe complications. Residual stones were detected in 12 patients, 4 of them received a second PCNL and 5 of them underwent postoperative ESML; one who received second PCNL and one who received ESML still showed a few residual stones in the lower renal calyces, the other 7 showed no residual stones after the second operation. Five of the 12 cases of residual stones were followed up for 6 to 24 months, 4 of them showed no significant change, and the other showed mildly enlarged renal stone. In the 46 patients who had the stones removed completely, follow-up was achieved for 3 to 34 months with a mean of 14.3 months, only 2 of them had recurrence and thus received conservative therapy. Conclusions: PCNL is safe and effective for elderly patients with renal stones. The keys of the therapy include adequate preoperative preparation, skilled operation, and perioperative management. Elderly patients with heart and lung function compensatory ability are poor, and accompanied by chronic disease of other system. So the surgery is risking. Our hospital from January 2013 to December 2015, using percutaneous nephrolithotomy (PCNL) in treatment of 57 elderly kidney stones, the operation risk control and satisfactory effect is good, reports are as follows.