Main Article Content



  1. Percutaneous nephrolithotomy (PCNL) in older patients is as effective and safe as in younger patients.

  2. It is a viable option for managing renal stones in older patients with indications, although blood transfusions are frequently required.


Percutaneous nephrolithotomy (PCNL) for renal and proximal ureteral stone treatment among the elder population is considered challenging due to the complication risk associated with comorbidity and lower functional reserve. Patients older and younger than 60 years old were compared for efficacy and safety in following PCNL procedures. Consecutive patients who underwent PCNL from 2019-2021 in a single center were divided into patients aged at least 60 years (group I) and patients aged under 60 years (group II). Single stage fluoroscopic-guided PCNL were used for the entire study population. Patients’ habitus, stone-related, and operative characteristics were compared. The two groups’ PCNL success and complication rates were evaluated. A total of 245 patients, comprising 65 in group I and 180 in group II, were included for analysis. Diabetes mellitus prevalence was higher in group I (30.8% vs 18.9%). However, the study population did not show a significant difference in regard to comorbidity. Operative time, success rate (80% vs 74.4%), and complication rate (16.9% vs 15.6%) did not statistically differ (p>0.05). Transfusion rate was higher among patients aged at least 60 years (p=0.018). Based on the multivariate analysis, stones located in the renal pelvis was the factor which contributed to the success rate. In conclusion, percutaneous nephrolithotomy is a safe and effective procedure for treating renal and proximal ureteral stones in the older population. Blood transfusions are more frequently given, in part, due to bleeding risk among older patients.


Percutaneous nephrolithotomy (PCNL) renal stone nephrolithiasis older adults life expectancy

Article Details

How to Cite
Ali, M. W., Azmi, Y. A., Tarmono, & Soebadi, D. M. (2023). Percutaneous Nephrolithotomy (PCNL) in Older and Younger Patients at a Tertiary Hospital in Surabaya, Indonesia. Folia Medica Indonesiana, 59(1), 26–31.


  1. Abedali ZA, Large T, Heiman JM, et al (2019). Percutaneous nephrolithotomy in the 80 years of age and older population. Urology 134, 62–5. doi: 10.1016/j.urology.2019.08.044.
  2. Alelign T, Petros B (2018). Kidney stone disease: An update on current concepts. Advances in Urology 2018, 1–12. doi: 10.1155/2018/3068365.
  3. Arampatzis S, Lindner G, Irmak F, et al (2012). Geriatric urolithiasis in the emergency department: Risk factors for hospitalisation and emergency management patterns of acute urolithiasis. BMC Nephrology 13, 117. doi: 10.1186/1471-2369-13-117.
  4. Buldu I, Tepeler A, Karatag T, et al (2015). Does aging affect the outcome of percutaneous nephrolithotomy? Urolithiasis 43, 183–7. doi: 10.1007/s00240-014-0742-4.
  5. Carrion DM, Cansino JR, Quintana LM, et al (2018). Prone percutaneous nephrolithotomy: Its advantages and our technique for puncture. Translational Andrology and Urology 7, 950–9. doi: 10.21037/tau.2018.10.04.
  6. Eisner BH, Sheth S, Herrick B, et al (2012). The effects of ambient temperature, humidity and season of year on urine composition in patients with nephrolithiasis. BJU International 110, E1014–7. doi: 10.1111/j.1464- 410X.2012.11186.x.
  7. Goldfarb DS, Hirsch J (2015). Hypothesis: Urbanization and exposure to urban heat islands contribute to increasing prevalence of kidney stones. Medical Hypotheses 85, 953–7. doi: 10.1016/j.mehy.2015.09.003.
  8. Gross A, Knipper S, Netsch C (2014). Managing caliceal stones. Indian Journal of Urology 30, 92. doi: 10.4103/0970-1591.124214.
  9. Han H, Segal AM, Seifter JL, et al (2015). Nutritional management of kidney stones (Nephrolithiasis). Clinical Nutrition Research 4, 137. doi: 10.7762/cnr.2015.4.3.137.
  10. Kurniawan R, Djojodimedjo T, Rahaju AS (2020). Profile of patients with urinary tract stone at Urology Department of Soetomo General Hospital Surabaya in January 2016-December 2016. Indonesian Journal of Urology 27, 22–5. doi: 10.32421/juri.v27i1.506.
  11. Lestari DA, Wahyuni ID, Yudhastuti R, et al (2019). Risk factors associated with urolithiasis in Arosbaya Health Center Bangkalan Regency, Indonesia. Malaysian Journal of Medicine and Health Sciences 15, 82–5.
  12. Meng X, Bao J, Mi Q, et al (2019). The analysis of risk factors for hemorrhage associated with minimally invasive percutaneous nephrolithotomy. Biomed Research International 2019, 1–6. doi: 10.1155/2019/8619460.
  13. Minister of Health of the Republic of Indonesia (2013). Riskesdas 2013.
  14. Morganstern B, Galli R, Motamedinia P, et al (2015). Percutaneous nephrolithotomy in octogenarians and beyond: How old is too old? Asian Journal of Urology 2, 208–13. doi: 10.1016/j.ajur.2015.08.005.
  15. Nakamon T, Kitirattrakarn P, Lojanapiwat B (2013). Outcomes of percutaneous nephrolithotomy: Comparison of elderly and younger patients. International Braz J Urol 39, 692–701. doi: 10.1590/S1677-5538.ibju.2013.05.12.
  16. Purnomo BB (2016). Dasar-dasar urologi. CV Sagung Seto, Jakarta.
  17. Rule AD, Lieske JC, Li X, et al (2014). The ROKS nomogram for predicting a second symptomatic stone episode. Journal of the American Society of Nephrology 25, 2878–86. doi: 10.1681/asn.2013091011.
  18. Sawal Z, Soebadi DM (2020). Impact of stone size, location, and stone composition on the efficacy of extracorporeal shock wave lithotripsy for residual stone after percutaneous nephrolithotomy. Folia Medica Indonesiana 56, 127. doi: 10.20473/fmi.v56i2.21231.
  19. Sutadji JT, Pranoto A, Prasetyo RV (2023). Risk factors of chronic kidney disease (CKD) in type 2 diabetes mellitus (DM) patients at Dr. Soetomo General Academic Hospital, Surabaya. JUXTA Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga 14, 12–6. doi: 10.20473/juxta.V14I12023.12-16.
  20. Tang X, Lieske JC (2014). Acute and chronic kidney injury in nephrolithiasis. Current Opinion in Nephrology and Hypertension 23, 385–90. doi: 10.1097/01.mnh.0000447017.28852.52.
  21. Usawachintachit M, Masic S, Allen IE, et al (2016). Adopting ultrasound guidance for prone percutaneous nephrolithotomy: Evaluating the learning curve for the experienced surgeon. Journal of Endourology 30, 856– 63. doi: 10.1089/end.2016.0241.
  22. Wei W, Leng J, Shao H, et al (2015). Diabetes, a risk factor for both infectious and major complications after percutaneous nephrolithotomy. International Journal of Clinical Experimental Medicine 8, 16620–6.
  23. Wicaksono F, Yogiswara N, Kloping YP, et al (2022). Comparative efficacy and safety between micro-percutaneous nephrolithotomy (micro-PCNL) and retrograde intrarenal surgery (RIRS) for the management of 10–20 mm kidney stones in children: A systematic review and meta-analysis. Annals of Medicine and Surgery 80, 104315. doi: 10.1016/j.amsu.2022.104315.
  24. Ziemba JB, Matlaga BR (2017). Epidemiology and economics of nephrolithiasis. Investigative and Clinical Urology 58, 299. doi: 10.4111/icu.2017.58.5.299.
  25. Zurriyani Z, Ichwani J, Widajanti N (2020). Several factors associated with nitrogen balance in elderly patients. Current Internal Medicine Research and Practice Surabaya Journal 1, 1. doi: 10.20473/cimrj.v1i1.16828.