Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population

Amy Krambeck, John C. Lieske, Xujian Li, Eric J. Bergstralh, L. Joseph Melton, Andrew D. Rule

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: We characterized variation in the clinical presentation between older and younger first time symptomatic stone formers in the general population. Materials and Methods: We studied a random sample of Olmsted County, Minnesota residents with their first diagnostic code for urolithiasis between 1984 and 2003. Chart validated symptomatic stone formers had a confirmed stone by imaging or stone passage. Clinical presentation characteristics were compared between age groups. Results: Among the 3,473 charts reviewed there were 1,590 validated incident symptomatic stone formers (mean age 43 years, range 18 to 96). Older individuals were more likely to present with atypical or no pain, fever, diarrhea, pyuria, urinary tract infections and bacteremia (p <0.001). Stone size and location did not differ by patient age. Calcium phosphate stone disease was associated with younger age, while uric acid stone and atypical stone composition was associated with older age (p <0.001). Older individuals were less likely to pass the stone spontaneously and were more likely to require surgical intervention (p <0.001). Surgical intervention was required in 516 (32.5%) individuals. Younger individuals were more likely to undergo ureteroscopy while older individuals were more likely to undergo shock wave lithotripsy, temporizing stent placement and percutaneous nephrolithotomy. Conclusions: The detection of stone disease in older individuals can be challenging due to atypical pain or absence of pain, as well as the presence of other comorbid conditions such as urinary tract infections and diarrhea. A higher index of suspicion for urolithiasis may be needed in the elderly for a more timely diagnosis and intervention to prevent morbidity.

Original languageEnglish (US)
Pages (from-to)158-164
Number of pages7
JournalJournal of Urology
Volume189
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Fingerprint

Urolithiasis
Urinary Tract Infections
Pain
Diarrhea
Pyuria
Population
Ureteroscopy
Percutaneous Nephrostomy
Lithotripsy
Bacteremia
Uric Acid
Stents
Fever
Age Groups
Morbidity

Keywords

  • age factors
  • epidemiology
  • urinary tract infections
  • urolithiasis

ASJC Scopus subject areas

  • Urology

Cite this

Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population. / Krambeck, Amy; Lieske, John C.; Li, Xujian; Bergstralh, Eric J.; Melton, L. Joseph; Rule, Andrew D.

In: Journal of Urology, Vol. 189, No. 1, 01.2013, p. 158-164.

Research output: Contribution to journalArticle

Krambeck, Amy ; Lieske, John C. ; Li, Xujian ; Bergstralh, Eric J. ; Melton, L. Joseph ; Rule, Andrew D. / Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population. In: Journal of Urology. 2013 ; Vol. 189, No. 1. pp. 158-164.
@article{3bd4175235574c1296fed34ea8888718,
title = "Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population",
abstract = "Purpose: We characterized variation in the clinical presentation between older and younger first time symptomatic stone formers in the general population. Materials and Methods: We studied a random sample of Olmsted County, Minnesota residents with their first diagnostic code for urolithiasis between 1984 and 2003. Chart validated symptomatic stone formers had a confirmed stone by imaging or stone passage. Clinical presentation characteristics were compared between age groups. Results: Among the 3,473 charts reviewed there were 1,590 validated incident symptomatic stone formers (mean age 43 years, range 18 to 96). Older individuals were more likely to present with atypical or no pain, fever, diarrhea, pyuria, urinary tract infections and bacteremia (p <0.001). Stone size and location did not differ by patient age. Calcium phosphate stone disease was associated with younger age, while uric acid stone and atypical stone composition was associated with older age (p <0.001). Older individuals were less likely to pass the stone spontaneously and were more likely to require surgical intervention (p <0.001). Surgical intervention was required in 516 (32.5{\%}) individuals. Younger individuals were more likely to undergo ureteroscopy while older individuals were more likely to undergo shock wave lithotripsy, temporizing stent placement and percutaneous nephrolithotomy. Conclusions: The detection of stone disease in older individuals can be challenging due to atypical pain or absence of pain, as well as the presence of other comorbid conditions such as urinary tract infections and diarrhea. A higher index of suspicion for urolithiasis may be needed in the elderly for a more timely diagnosis and intervention to prevent morbidity.",
keywords = "age factors, epidemiology, urinary tract infections, urolithiasis",
author = "Amy Krambeck and Lieske, {John C.} and Xujian Li and Bergstralh, {Eric J.} and Melton, {L. Joseph} and Rule, {Andrew D.}",
year = "2013",
month = "1",
doi = "10.1016/j.juro.2012.09.023",
language = "English (US)",
volume = "189",
pages = "158--164",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Effect of age on the clinical presentation of incident symptomatic urolithiasis in the general population

AU - Krambeck, Amy

AU - Lieske, John C.

AU - Li, Xujian

AU - Bergstralh, Eric J.

AU - Melton, L. Joseph

AU - Rule, Andrew D.

PY - 2013/1

Y1 - 2013/1

N2 - Purpose: We characterized variation in the clinical presentation between older and younger first time symptomatic stone formers in the general population. Materials and Methods: We studied a random sample of Olmsted County, Minnesota residents with their first diagnostic code for urolithiasis between 1984 and 2003. Chart validated symptomatic stone formers had a confirmed stone by imaging or stone passage. Clinical presentation characteristics were compared between age groups. Results: Among the 3,473 charts reviewed there were 1,590 validated incident symptomatic stone formers (mean age 43 years, range 18 to 96). Older individuals were more likely to present with atypical or no pain, fever, diarrhea, pyuria, urinary tract infections and bacteremia (p <0.001). Stone size and location did not differ by patient age. Calcium phosphate stone disease was associated with younger age, while uric acid stone and atypical stone composition was associated with older age (p <0.001). Older individuals were less likely to pass the stone spontaneously and were more likely to require surgical intervention (p <0.001). Surgical intervention was required in 516 (32.5%) individuals. Younger individuals were more likely to undergo ureteroscopy while older individuals were more likely to undergo shock wave lithotripsy, temporizing stent placement and percutaneous nephrolithotomy. Conclusions: The detection of stone disease in older individuals can be challenging due to atypical pain or absence of pain, as well as the presence of other comorbid conditions such as urinary tract infections and diarrhea. A higher index of suspicion for urolithiasis may be needed in the elderly for a more timely diagnosis and intervention to prevent morbidity.

AB - Purpose: We characterized variation in the clinical presentation between older and younger first time symptomatic stone formers in the general population. Materials and Methods: We studied a random sample of Olmsted County, Minnesota residents with their first diagnostic code for urolithiasis between 1984 and 2003. Chart validated symptomatic stone formers had a confirmed stone by imaging or stone passage. Clinical presentation characteristics were compared between age groups. Results: Among the 3,473 charts reviewed there were 1,590 validated incident symptomatic stone formers (mean age 43 years, range 18 to 96). Older individuals were more likely to present with atypical or no pain, fever, diarrhea, pyuria, urinary tract infections and bacteremia (p <0.001). Stone size and location did not differ by patient age. Calcium phosphate stone disease was associated with younger age, while uric acid stone and atypical stone composition was associated with older age (p <0.001). Older individuals were less likely to pass the stone spontaneously and were more likely to require surgical intervention (p <0.001). Surgical intervention was required in 516 (32.5%) individuals. Younger individuals were more likely to undergo ureteroscopy while older individuals were more likely to undergo shock wave lithotripsy, temporizing stent placement and percutaneous nephrolithotomy. Conclusions: The detection of stone disease in older individuals can be challenging due to atypical pain or absence of pain, as well as the presence of other comorbid conditions such as urinary tract infections and diarrhea. A higher index of suspicion for urolithiasis may be needed in the elderly for a more timely diagnosis and intervention to prevent morbidity.

KW - age factors

KW - epidemiology

KW - urinary tract infections

KW - urolithiasis

UR - http://www.scopus.com/inward/record.url?scp=84870888795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870888795&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2012.09.023

DO - 10.1016/j.juro.2012.09.023

M3 - Article

VL - 189

SP - 158

EP - 164

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 1

ER -