Shock wave Lithotripsy in the Elderly: Our Experience Related to Literature Review

Abstract

Background The more and more common use of abdominal ultrasonography and of other imaging techniques, the increase of the life expectancy and therapies for calcium metabolism, has led to a higher diagnosis rate of renal stones in the elderly. At the moment, extracorporeal shock wave lithotripsy is considered the first-line therapy in the majority of reno-ureteral stones. Objectives To prove the efficacy and safety of extracorporeal shock wave lithotripsy also in the elderly population. Materials and Methods We proceeded to a retrospective study on patients aged over 70 years, who underwent SWL at our division from January 1996 to April 2005, with Storz Modulith SLX electromagnetic lithotripter. We defined as 'stone-free those patients who did not show any stone fragment in the following ultrasonography and abdomen X-ray control. In addition, we performed a medium/long-term follow-up. We adopted as “control group” 115 patients aged less than 60 years, who underwent lithotripsy with the same lithotripter from June 2007 to January 2008. Results In the short-term follow-up, at the end of the single treatment or of the course of treatments (1-3 months after treatment), we observed: 72.1% (83/115) stone-free subjects, 20% (23/115) of cases with stone fragments that could be eliminated (<4 mm), 3.5% (4/115) with stone fragments >4 mm, 4.3% (5/115) unchanged cases; 2 of these (1.7%) underwent endoscopic lithotripsy and one percutaneous lithotripsy (0.9%). Concerning the medium/long-term follow-up (mean 59.2 months, range 7 mo-108 mo), we observed: 59.8% (67/112) stone-free cases, 25.9% (29/112) recurring stones, 11.6% (13/112) re-growth, 2,7% (3/112) unchanged cases. In the short-term follow-up, comparing the study group with the control one we observed: – No statistically significant difference regarding the treatment side effects in the two groups; – A lower stone-free percentage in caliceal stones in the elderly than in the younger patients (SFR = 62.5% vs 70.3%) – A stone-free percentage for non-caliceal stones similar in the older and the young patients (SFR = 79.1% vs 80.4%). Conclusions Shock wave lithotripsy proves to be effective in the first-line treatment of renal stones in the elderly, yielding good results with no increase of side effects.