Safety and efficacy of ureteroscopy for urolithiasis in octogenarians

• Published in: International journal of urology Vol. 30; no. 2; pp. 161 - 167
• Main Authors: Koterazawa, Shigeki, Kanno, Toru, Takahashi, Toshifumi, Somiya, Shinya, Ito, Katsuhiro, Haitani, Takao, Arakaki, Ryuichiro, Kawase, Norio, Higashi, Yoshihito, Yamada, Hitoshi
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01-02-2023
• Subjects: Aged, 80 and over; Complications; Diabetes; Diabetes mellitus; Female; Fever; Humans; Lithiasis; Multivariate analysis; Octogenarians; Patients; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Pyelonephritis; Regression analysis; Retrospective Studies; Risk factors; Statistical analysis; stone‐free rate; Treatment Outcome; Ureteral Calculi - surgery; ureteroscopy; Ureteroscopy - adverse effects; Ureteroscopy - methods; Urinary tract diseases; urolithiasis; Urolithiasis - etiology; Urolithiasis - surgery; urolithiasis; octogenarians; complications; ureteroscopy; stone-free rate
• ISSN: 0919-8172; 1442-2042; 1442-2042
• DOI: 10.1111/iju.15073

Objective
To examine the safety and efficacy of ureteroscopy (URS) for urolithiasis in octogenarians, and identify preoperative risk factors for the incidence of postoperative complications.
Methods
The patients who underwent URS for urolithiasis were divided into octogenarians and younger patients (age: <80 years), and the groups were compared regarding their clinical characteristics, intraoperative and postoperative complications, and stone‐free rate. The predictors of postoperative complications were evaluated using logistic regression models.
Results
A total of 1207 patients were included, 166 in the octogenarian patient group and 1041 in the younger patient group. The proportion of female patients (p < 0.001), American Society of Anesthesiologists (ASA) score (p < 0.001), rate of preoperative pyelonephritis (p < 0.001), and diabetes mellitus (p = 0.003) were higher in the octogenarian group. No statistically significant differences were found between the two groups regarding stone size, location, and intraoperative complications. Postoperative complications, which reached a significant difference, were observed in 34 (20.5%) octogenarians and 117 (11.2%) younger patients (p = 0.002). However, age itself was not significantly associated with postoperative fever, the most frequent postoperative complication, in multivariate analysis. Female sex, ASA score of ≥3, history of diabetes mellitus, and prolonged operative time (≥120 min) were the significant predictors of fever. The stone‐free rate in the octogenarian group was superior to that in the younger patient group (80.1% vs. 70.6%, respectively; p = 0.035).
Conclusion
Our results suggest that URS for urolithiasis can be safely and effectively applied to octogenarians in selected cases.