Mode
Home
Conditions Medications Drug Pipeline Weekly Digests Questions
Text Size
Log in / Sign up
Home › Questions › Nephrology

Are complication risks for kidney stone surgery higher in elderly patients?

high confidence  ·  Last reviewed May 18, 2026

Kidney stone surgery in elderly patients does carry some added risks, but the picture is nuanced. A large meta-analysis of percutaneous nephrolithotomy (PCNL) found that overall complication rates were not significantly higher in elderly patients compared to younger ones, though the risk of postoperative sepsis was about four times higher 3. For other common procedures like ureteroscopy (RIRS), age is one factor among many used to predict infection risk, but it is not the strongest predictor 7. The choice of surgery and the patient's overall health matter more than age alone.

What the research says

A 2026 meta-analysis of 17 studies including over 45,000 patients compared PCNL outcomes in elderly versus non-elderly patients. When all age cutoffs were combined, overall complications (odds ratio 1.20) and major complications (odds ratio 1.39) were not statistically different between groups 3. However, elderly patients had a significantly higher risk of postoperative sepsis (odds ratio 3.94) 3. In subgroup analyses using a 70-year age cutoff, the risk of overall complications did become significantly higher (odds ratio 1.26) 3. Stone-free rates were similar between age groups 3.

For retrograde intrarenal surgery (RIRS), a 2024 study developed a machine learning model to predict sepsis after surgery. The model included age along with other factors like stone volume, surgical time, and urine culture results 7. Age was a variable in the model, but it was not the most important predictor 7. This suggests that while age contributes to risk, other factors may be more influential.

A 2023 Cochrane review comparing ESWL, PCNL, and RIRS noted that complication rates for RIRS and PCNL have decreased due to improvements in surgical techniques and instruments 6. This means that for many elderly patients, modern surgical approaches may be safer than in the past.

Other sources did not directly address age-related risks. One study compared RIRS with thulium fiber laser to PCNL for medium-sized stones and found no difference in complications, but it did not focus on elderly patients 4. Another review discussed negative-pressure suction sheaths during ureteroscopy, which may reduce infectious complications in vulnerable patients, but did not specifically analyze age 2.

What to ask your doctor

  • Given my age and overall health, what is my personal risk of complications like sepsis or bleeding with PCNL versus RIRS?
  • Would a less invasive procedure like ureteroscopy (RIRS) be a safer option for me than PCNL?
  • How does my kidney stone size and location affect the choice of surgery and the associated risks?
  • What steps will be taken to reduce my risk of infection during and after the procedure?
  • Are there any pre-surgery tests (like urine culture or heart/lung evaluation) that you recommend before deciding on surgery?

This question is drawn from common patient questions about Nephrology and answered using cited medical research. We do not provide individualized advice.