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首页> 外文期刊>Arab Journal of Urology >Shock-wave lithotripsy in the elderly: Safety, efficacy and special considerations
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Shock-wave lithotripsy in the elderly: Safety, efficacy and special considerations

机译：老年人冲击波碎石术：安全性，有效性和特殊考虑

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Purpose Shock-wave lithotripsy (SWL) for elderly patients can be challenging. Patients often have a long-standing complex stone burden and significant comorbidities. We report a cohort of patients aged ?70years who were treated by SWL, with special attention to treatment outcomes, complications and the need for adjuvant procedures. Patients and methods Over a period of 4years, 2311 patients were treated with SWL in a tertiary referral centre. Among these patients, 137 were aged ?70years (5.9%). Patient and stone data were obtained from an electronic database and the patients’ electronic medical records were reviewed. Results During the pre-procedural assessment, 29 patients (21.2%) were considered to be at high anaesthetic risk, due their comorbidities (American Society of Anesthesiology score 3+). In terms of stone burden, 16 stones (11.7%) were located in the distal ureter (mean stone diameter 7.9mm) and 28 (20.4%) were in the proximal ureter (mean diameter 10.1mm). In the kidney, 54 stones (39.4%) were in the renal pelvis, upper or mid calyx (mean diameter 10.6mm), while 39 stones (28.5%) were in the lower calyx (mean diameter 10.1mm). The median (range) number of SWL sessions per patient was 2.0(1–3). The overall stone-free rate achieved by SWL alone was 63.5% (65.9% for ureteric stones and 62.4% for renal stones). In total, 38 patients (27.7%) had an adjuvant procedure to achieve stone clearance (ureteroscopy in 23, PCNL in 14 and laparoscopic ureterolithotomy in one case). Apart from six cases (4.3%) of ureteric obstruction due to steinstrasse, there were no severe complications noted. Conclusions The management of elderly patients presenting with urolithiasis is challenging, due to the presence of significant comorbidities. Careful assessment of an integrated management plan for geriatric patients with urolithiasis is essential, and SWL still remains a safe and efficient first-line tool in well-selected cases.
机译：目的老年患者的冲击波碎石术（SWL）可能具有挑战性。患者常有长期的复杂结石负担和明显的合并症。我们报道了一组接受SWL治疗的年龄≥70岁的患者，特别关注治疗结果，并发症和辅助手术的必要性。患者和方法在4年的时间里，有2311名患者在三级转诊中心接受了SWL治疗。在这些患者中，有137位年龄≥70岁（5.9％）。病人和结石数据是从一个电子数据库中获得的，并且对病人的电子病历进行了审查。结果在术前评估中，有29例（21.2％）患者由于合并症而被认为具有较高的麻醉风险（美国麻醉学会评分3+）。就结石负荷而言，在输尿管远端（平均结石直径为7.9mm）有16块结石（占11.7％），在输尿管近端（平均直径为10.1mm）有28块（占结石的20.4％）。在肾脏中，肾盂上部或中部萼片（平均直径10.6mm）中有54个结石（占39.4％），下部萼片（平均直径10.1mm）中有39个结石（28.5％）。每位患者的SWL疗程中位数（范围）为2.0（1-3）。单独通过SWL可获得的总体无结石率为63.5％（输尿管结石为65.9％，肾结石为62.4％）。共有38例患者（27.7％）接受了辅助手术以实现结石清除（输尿管镜检查23例，PCNL术14例，腹腔镜输尿管结石术1例）。除了因施行施行施行施行施行施行施行施行施泰施特施（straßstrasse）的输尿管阻塞6例（4.3％）外，未发现严重并发症。结论由于存在重大合并症，对患有尿石症的老年患者的治疗具有挑战性。认真评估针对尿路结石病的老年患者的综合管理计划至关重要，而且SWL在精选的病例中仍然是安全有效的一线工具。

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