Presented by: Micah Levy
Icahn School of Medicine at Mount Sinai

Introduction

Ureteroscopy (URS) is a safe and effective method for stone removal. However, few studies have identified the safety and efficacy of URS in the elderly population, specifically those 80 years and older. We analyzed URS outcomes in the octogenarian and nonagenarian populations as compared to those of the younger population across a large New York City hospital system.

Materials

Patients receiving URS for stone management at our institution between 2017 -2019 were retrospectively reviewed. Demographics, stone characteristics, and surgical outcomes including stone free rate (SFR), complications, and imaging follow up were recorded. Analysis compared patients ≥  80 years old (elderly) to those < 80 years old (control) using a 1:3 ratio while matching patients based on American Society of Anesthesiology (ASA) scores.

Results

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80 elderly patients (ASA 2: 28, ASA > 3: 52) matched to 240 control patients (ASA 2: 84, ASA > 3: 156) were analyzed. The median age was 83 for elderly patients and 61 for controls. Elderly patients had significantly lower BMI (25.24 vs. 28.81, p < 0.001), statistically significant, but clinically insignificant smaller primary stone size (0.7 cm vs. 0.8 cm, p = 0.028), and higher rates of prior stenting (40.58% vs. 23.49%, p = 0.015). There were no significant differences in other demographic or stone characteristics. There were no significant differences in SFR for primary stones (77.19% vs. 84.21%, p = 0.315) or secondary/non-obstructive stones (91.07% vs. 88.89%, p = 0.804), nor were there differences in operative times, rate of same-day-discharge, or rates of complications and reoperations. Lastly, while there were no differences in the rate of 365-day imaging follow up (65.00% vs. 65.69%, p > 0.999), elderly patients did have a higher rate of imaging follow up within the recommended 90-day post-operative period (78.85% vs. 54.72%, p = 0.003). These results remained consistent with multivariate analysis controlling for demographic and preoperative stone characteristics.

Conclusion

URS is a safe and effective method for stone management in the octogenarian and nonagenarian population with equivalent SFR and complication rates, and potentially more consistent follow-up when compared to the younger population.

Funding

Partial funding from the Endourology Society Summer Scholarship awarded to Micah Levy. 

Co-Authors

Daniel Wang,
Icahn School of Medicine at Mount Sinai

Christopher Connors,
Icahn School of Medicine at Mount Sinai

Aaron Walt,
Icahn School of Medicine at Mount Sinai

Jacob Stifelman,
Icahn School of Medicine at Mount Sinai

Olamide Omidele,
Icahn School of Medicine at Mount Sinai

Francisca Larenas,
Icahn School of Medicine at Mount Sinai

Michael Palese,
Icahn School of Medicine at Mount Sinai