Percutaneous Nephrolithotomy in the Elderly

Abstract

Since may 1982, over 170 cases of urolithiasis has been treated by percutaneous nephrolithotomy (PNL). In these cases, 14 patients elder than 60 years were noticed. We discussed some problems especial to aged peoples compared with youngers. A patient was laid on the fluoroscopic table in the prone position under epidural anesthesia. Percutaneous nephrostomy was made under fluoroscopic control. The endoscope was inserted through the nephrostomy, stone was fractured and removed by special stone forceps. Especially for large or hard stones, Mazzariello-Caprini forceps and Kocher's forceps were found unexpectedly useful. Overall cases consisted of 121 males and 51 females (sex ratio 2.4:1), and aged group consisted of 9 males and 5 females (sex ratio 1.8:1). The increase of female ratio was noticed in aged group. One ureteral stone case was failed stone removal by PNL, and operated traditional ureterolithotomy. One pelvic stone patient who had basically hypertension and arrhythmia died soon after PNL because of acute myocardial infarction. The residual stone over 5mm was noticed in 3 cases (23%). Average hospitalized days of aged group was 27.8, and the days after PNL was 21.5, compared with youngers the former was 5 days and the latter was 3.5 days longer. Because the extracorporeal shock wave lithotriptor is now beginning to work in Japan, PNL and ureteroscopic ureterolithotomy if performed widely, the traditional open operation is reducing day by day. But any method is selected, the anesthesia is necessary and the risk of the anesthesia is not diminished. As PNL is performed in the prone position and under epidural anesthesia, if the level of anesthesia goes upward, respiratory disturbance may occur. Reabsorption of irrigation fluid from mucosa or vein during endoscopic manipulation may result in circulatory overload. For the aged patients, who have decreased force or reserve of pulmonary, cardiac and renal function, these overload make the risk of PNL much higher compared with youngers. So the indication of PNL for the elderly should be selected strictly according to one's complications.