Active stone removal is a safe option for ocotogenarians and nonagenarians with nephrolithiasis.

Abstract

To assess the contemporary in-hospital management of octogenarians and nonagenarians with renal calculi. A multicentric retrospective evaluation of patients aged ≥ 80years hospitalized with kidney stones between 01/2000 and 12/2019. Stone and patient related data were collected, including stone size and location, geriatric status and comorbidities. Surgical treatment patterns and outcome were assessed. A total of 299 patients (57% female) with kidney stones were analyzed. Mean age was 84.7years. Patients were largely multimorbid (ASA ≥ 3 in 70%) and about 25% were classified as frail. Active stone treatment was performed in 65% and 35% were treated with urinary diversion (stent or nephrostomy). Prognostic factors for receiving an active stone treatment were age < 90years, male sex, stone size and quantity, and performance status. Mean overall survival was 23.7months and when stratified to treatment mean survival were 21months after urinary diversion, 28months after URS, 29months after PCNL and 45months after SWL. Age, frailty and performance-status as well as stone size and quantity are predictors for active stone treatment. Octogenarians and nonagenarians, who are considered fit for surgery, tend to live long enough to profit from active stone treatment.