Safety and efficacy of percutaneous nephrolithotomy in elderly patients: a systematic review and meta-analysis by the EAU-YAU urolithiasis and EAU endourology sections

PURPOSE: The aim of this study was to evaluate differences in safety and efficacy outcomes of PCNL between elderly and non-elderly patients, with special focus on commonly applied age cut-off values. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of PCNL in elderly versus non-elderly patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to February 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to different age thresholds used to define elderly populations (60, 65, and 70 years). RESULTS: Seventeen studies encompassing 45,603 patients, including 10,745 elderly individuals, were included. When pooled across all age definitions, rates of overall complications (OR 1.20, 95%CI 0.95-1.53) and major complications (OR 1.39, 95%CI 0.92-2.10) did not differ significantly between elderly and younger patients. Elderly patients demonstrated a significantly higher risk of postoperative sepsis (OR 3.94, 95%CI 1.83-8.47). SFR were comparable between groups. In subgroup analyses, studies applying a 70-year age cut-off demonstrated a significantly increased risk of overall complications (OR 1.26, 95% CI 1.03-1.55) and major complications (OR 1.95, 95% CI 1.15-3.31), whereas no significant differences were observed in studies using 60- or 65-year thresholds. CONCLUSIONS: PCNL can be performed safely in elderly patients, with SFR and complication profiles comparable to those observed in younger individuals when data across different elderly definitions are pooled. However, overall and major complications increases progressively with advancing age within the elderly population, especially among patients aged ≥ 70 years.