Health status assessment and surgical decision-making for older adults in urology: Results from an International Survey of the EAU Young Academic Urology Group

INTRODUCTION: Older adults represent an increasing proportion of urological patients and often present with frailty, multimorbidity, and functional decline, complicating clinical decision-making. This study explored urologists' perspectives and practices in managing older and/or frail patients. MATERIALS AND METHODS: An international, anonymised, cross-sectional survey based on a modified SIOG questionnaire was distributed via the EAU Young Academic Urology network and social media (February 2026). Domains included demographics, geriatric assessment practices, decision-making factors, and training perspectives. Descriptive statistics were used. RESULTS: A total of 102 urologists responded, predominantly consultants (71.6%) and based in Europe (89.2%). Routine geriatrician involvement was limited (15%), with 19.4% reporting no access. While most respondents were familiar with frailty concepts (74.5%), only 13.8% reported routine use of formal tools. Decision-making was driven primarily by comorbidity burden (78.5%), functional status (52.7%), anaesthetic assessment (50.5%), and frailty status (48.4%), whereas formal tools (5.4%) and chronological age (24.7%) were less influential. Anaesthetic opinion and anticipated recovery burden strongly influenced decisions. Most clinicians routinely discussed recovery and quality of life. Over 90% supported inclusion of frailty assessment in training. CONCLUSION: Frailty is recognised but underutilised in urological practice. Greater integration of simple assessment tools, geriatric expertise, and targeted training is needed to improve care for older patients.