Category: Clinical Stones: PCNL

MP32-20 - Safety and Feasibility of Percutaneous Nephrolithotomy (PCNL) in Septuagenarians and Older Patients.

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective : With the increasingly elderly population with multiple comorbidities we need to adapt our practices to keep up with the demand of such a complex patient group. We believe that PCNL is a suitable method for large renal and staghorn calculi in this group.

Our aim was to study the feasibility of PCNL as a management option for patients with renal calculi in the elderly and to assess postoperative complications and potential for patients to undergo further treatment putting them at risk of a further GA

Methods :

A prospective audit looking at all patients in a single surgeon cohort who underwent elective PCNL over a 6 year period was done and data obtained on stone features, the initial recovery period, inpatient stay, completion of PCNL and requirement for further procedures.

Results :

38 patients aged between 70 and 85 with a mean age of 76 underwent PCNL over the 6 years studied. 6 of these patients had a staghorn calculus and 2 had encrusted calcified ureteric stents treated. The range of non staghorn calculi was 14mm to 47mm with an average size of 24mm. Density ranged from 442HU to 1817HU with an average of 1127HU. Initially all procedures were performed with the patient prone but preference changed to supine as time passed with 20 patients being operated on whilst supine. A flexible ureteroscope was used in 13 cases to directly visualise the puncture.

Of the 38 cases, 26 had a complete clearance with 12 having residual fragments the largest of which was 8mm. Of those 12 cases, 8 of them required  further treatment either by ESWL or FURS. Post operatively 11 patients had a post operative pyrexia but only 5 of these were deemed to be septic. 1 of these had a perinephric collection which required opening of the surgical wound but no formal draining and was managed with antibiotics. Blood transfusion was required in 3 patients, 2 received 2 units and another requiring only 1. It is worth noting that none of these patients had puncture under direct vision by FURS. Post operative stay ranged from 2 to 19 days, with the longest having the perinephric collection. The average was 4.6 days.

Conclusions :

PCNL is a successful, safe and viable option for treatment of renal calculi of varying size and density with comparable complication risks to those published for the general population.

Alasdair Boden

LAS in Urology
Monklands University Hospital
Airdrie, Scotland, United Kingdom

Leenesh Mokool

LAS in Urology
Monklands University Hospital
Airdrie, Scotland, United Kingdom

William Maynard

Monklands Hospital
Glasgow, Scotland, United Kingdom

Mr. William Maynard MRCSEd MBChB BMedSc, CT2 West of Scotland Deanery, Current hospital Forth Valley Royal Hospital

Sarath Nalagatla

Consultant Urologist
Monklands University Hospital
Airdrie, Scotland, United Kingdom