To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals.

From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999-2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes.

Of the 1,647 patients, median age was 46, 66 and 83 respectively (p<0.0001). 3 patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (p=0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (p=0.06). Mean pre-operative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, p<.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; p=0.02) and transfusions (2.3, 4.7, 10.2%; p<0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted.

PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long term survival.

Urology. 2019 Sep 16 [Epub ahead of print]

Zain A Abedali, Tim Large, Joshua M Heiman, Elhaam Bandali, Blake B Anderson, James E Lingeman, Amy E Krambeck

Department of Urology; Indiana University/IU Health Physicians, Indianapolis, IN., Department of Urology; Indiana University/IU Health Physicians, Indianapolis, IN. Electronic address: .