Efficacy and Safety of Retrograde Intrarenal Surgery in Geriatric Patients: A Single-Center Experience

Abstract

Background: In this study, we aimed to investigate the efficacy and safety of RIRS in patients over 65 years of age. Materials and Methods: 107 patients over 65 who underwent RIRC in our clinic were evaluated retrospectively. The patients were divided into two groups, according to whether there were complications (Group: No complications, Group 2: There are complications) and according to age (Group 1: 65-74 years, Group 2: 75 years and above). The groups were compared with each other regarding stone-free rate, complication rate, stone characteristics, and hospital stay. Results: When divided into groups according to age, no difference was observed between group 1 (65-74 years old) and group 2 (75 years and older) in terms of American Society of Anesthesiogists score, stone size, number of stones, and Hounsfield unit of the stone. On the other hand, it was observed that the hospital stay and complication rate of group 2 were higher than group 1. (p-value 0.01 and 0.02, respectively). The patients were divided into two groups according to whether there were complications. There was no significant difference in ASA score, Hounsfield unit of stone, and stone-free rate between group 1 (without complications) and group 2 (with complications). (p-value respectively: 0.127, 0.915, 0.379 ) Conclusion: With the increasing elderly population in the world, more elderly patients with kidney stones will apply for treatment. Therefore, as in our study, RIRS can be widely used in treating kidney stones in elderly patients in terms of efficacy and safety.

Keywords

• Kidney stone
• Retrograde Intrarenal Surgery (RIRS)
• Geriatrics patients

Geriatrik Hastalarda Retrograd İntrarenal Cerrahinin Etkinliği ve Güvenilirliği: Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmada 65 yaş üstü hastalarda RIRS'ın etkinlik ve güvenliğini değerlendirmeyi amaçladık. Materyal ve Metod: Kliniğimizde RIRC yapılan 65 yaş üstü 107 hasta retrospektif değerlendirildi. Hastalar hem komplikasyon olup olmasına göre (Grup:1 Komplikasyon yok, Grup 2: Komplikasyon var ) hem de yaşa göre iki gruba (Grup 1:65-74 yaş, Grup 2: 75 yaş ve üzeri) ayrıldı. Taşsızlık oranı, komplikasyon oranı, taş özellikleri, hastanede kalış süreleri açısından gruplar birbirleriyle karşılaştırıldı. Bulgular: Yaşa göre gruplara ayrıldığında grup (65-74 yaş) grup 2 (75 yaş ve üzeri ) arasında American Society of Anesthesiogists skoru, taş boyutu, taş sayısı ve taşın hounsfield ünitesi açısından fark gözlenmedi. Diğer yandan grup 2'nin hastanede kalış süresi ve komplikasyon oranının grup 1'e göre daha fazla olduğu gözlendi. (sırasıyla p değeri 0,01 ve 0,02) Hastalar komplikasyon görülme durumuna göre iki gruba ayrıldı. Grup1 (komplikasyon olmayan) ve grup 2 (komplikasyon olan) arasında ASA skoru, taşın hounsfield ünitesi ve taşsızlık oranında anlamlı fark saptanmadı. (sırasıyla p değeri: 0.127, 0.915, 0.379 ) Sonuç: Yaşlı nüfusun dünyada giderek artmasıyla böbrek taşı olan daha çok yaşlı hasta tedavi için başvuracaktır. Bu nedenle çalışmamız sonucunda olduğu gibi RIRS yaşlı hastalarda böbrek taşı tedavisinde etkinlik ve güvenlik açısından yaygın şekilde kullanılabilir.

Keywords

• Böbrek taşı
• Retrograd İntrarenal Cerrahi (RIRC)
• Geriatrik hasta

References

1. 1.Kittanamongkolchai W, Vaughan LE, Enders FT, Dhondup T, Mehta RA, Krambeck AE, et al. The Changing Incidence and Presentation of Urinary Stones Over 3 Decades. Mayo Clinic Proceedings. 2018;93(3):291-9.
2. 2.Knoll T, Schubert AB, Fahlenkamp D, Leusmann DB, Wendt-Nordahl G, Schubert G. Urolithiasis through the ages: data on more than 200,000 urinary stone analyses. J Urol. 2011;185(4):1304-11.
3. 3.Rule AD, Lieske JC, Li X, Melton LJ, Krambeck AE, Bergstralh EJ. The ROKS nomogram for predicting a second symptomatic stone episode. J Am Soc Nephrol. 2014;25(12):2878-86.
4. 4.Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. European Urology. 2016;69(3):475-82.
5. 5.Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A. Categorizing intraoperative complications of retrograde intrarenal surgery. Urol Int. 2014;92(2):164-8.
6. 6.Sun X, Xia S, Lu J, Liu H, Han B, Li W. Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. J Endourol. 2008;22(5):913-7. 7.United Nations, Department of Economic and Social Afairs, Population Division. (2019). World Population Ageing 2019: Highlights (ST/ESA/SER.A/430).
7. 8.Gökce Mİ, Akpinar Ç, Obaid K, Süer E, Gülpinar Ö, Bedük Y. Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population. International braz j urol : official journal of the Brazilian Society of Urology. 2021;47(1):64-70.
8. 9.Batur AF, Gülmen M, Böcü K, Altıntaş E, Gül M, Kaynar M. ve ark. . Retrograt intrarenal cerrahi geriatrik erkek hastalarda böbrek taşı tedavisinde etkin ve güvenilir bir seçenek midir? Genel Tıp Dergisi 2021(4):396-401.

9. 10.Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health, functioning, and disability in older adults--present status and future implications. Lancet. 2015;385(9967):563-75.
10. 11.Arampatzis S, Lindner G, Irmak F, Funk GC, Zimmermann H, Exadaktylos AK. Geriatric urolithiasis in the emergency department: risk factors for hospitalisation and emergency management patterns of acute urolithiasis. BMC Nephrol. 2012;13:117.
11. 12.Cakici MC, Sari S, Selmi V, Sandikci F, Karakoyunlu N, Ozok U. Is the Efficacy and Safety of Retrograde Flexible Ureteroscopy in the Elderly Population Different from Non-elderly Adults? Cureus. 2019;11(6):e4852.
12. 13.Gokcen K, Dundar G, Bagcioglu M, Karagoz MA, Gokce G, Sarica K. Safety and Efficacy of RIRS in Geriatric Patients: A Comparative Evaluation on an Age Based Manner. Urol J. 2020;17(2):129-33.
13. 14.Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D, et al. RIRS in the elderly: Is it feasible and safe? Int J Surg. 2017;42:147-51.
14. 15.Akman T, Binbay M, Ugurlu M, Kaba M, Akcay M, Yazici O, et al. Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis. J Endourol. 2012;26(6):625-9.
15. 16.Ozgor F, Yanaral F, Savun M, Ozdemir H, Caglar U, Sarilar O. Comparison of miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy for moderate size renal stones in elderly patients. Kaohsiung J Med Sci. 2018;34(6):352-6.
16. 17.Prattley S, Voss J, Cheung S, Geraghty R, Jones P, Somani BK. Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature. Int Braz J Urol. 2018;44(4):750-7.
17. 18.Hu H, Lu Y, He D, Cui L, Zhang J, Zhao Z, et al. Comparison of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of intermediate proximal ureteral and renal stones in the elderly. Urolithiasis. 2016;44(5):427-34.