Extracorporeal shockwave lithotripsy in elderly: impact of age and comorbidity on stone-free rate and complications.

INTRODUCTION: The aim of this study was to investigate and compare the success and complication rates of extracorporeal shockwave lithotripsy (SWL) in three cohorts of patients older than 60 years. PATIENTS AND METHODS: Our study included 444 patients older than 60 years who were treated with SWL between May 2001 and May 2008 at the Croatian Referential Center for Urolythiasis in Osijek. Three groups were formed: group I (60-65 years old), group II (66-70), and group III (> 70). There were 175, 151, and 118 patients in groups I, II, and III, respectively, with a mean age of 67.7 ± 5.4 years for all patients. Demographic data, comorbidities, kidney function, stone characteristics, treatment details, complications, and stone-free rate (SFR) were analyzed. RESULTS: We performed 1.7 ± 1.12 sessions per patient, with 3166 ± 571.3 impulses per session and a mean energy of 18.78 ± 0.64 kV. Three groups did not differ in number of SWL sessions (p = 0.78), number of impulses (p = 0.34), energy level (p = 0.5), stone size (p = 0.3), and pretreatment creatinine level (p = 0.88). Comorbidities were found in 55% of patients, with almost every third patient having two or more ones present. Complications were noted in 6% of patients, with no significant difference when comparing complication rates between the groups. An overall SFR of 67.98% was found. There was no statistically significant difference when comparing SFRs between the studied groups, even after dividing patients into those with renal and ureteral stones. CONCLUSION: Our study shows that good SFR and low rate of complications can be achieved with proper patient selection for SWL, regardless of patients' age and comorbidities.