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Complication risks in elderly patients undergoing percutaneous nephrolithotomy compared to younger populationsOlder patients can safely undergo kidney stone surgery with careful care

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Key Takeaway
Note that while PCNL outcomes are often comparable in elderly patients, those aged 70 or older face increased risks.

This systematic review and meta-analysis evaluated the clinical outcomes of percutaneous nephrolithotomy (PCNL) in elderly patients compared to non-elderly populations. The analysis included a total of 45,603 patients, of which 10,745 were identified as elderly individuals. The study utilized various age thresholds to define the elderly population, including 60, 65, or 70 years. The researchers examined the association between patient age and several key outcomes, including overall, minor, and major complications, as well as the stone-free rate (SFR).

When pooling data across all age definitions, the meta-analysis found no significant difference in overall complications between elderly and younger patients, reporting an odds ratio (OR) of 1.20 (95% CI 0.95-1.53). Similarly, no significant difference was observed for major complications, with an OR of 1.39 (95% CI 0.92-2.10). The stone-free rate (SFR) was also found to be comparable between the two groups. However, a critical finding was the significantly higher risk of postoperative sepsis in elderly patients, which demonstrated an OR of 3.94 (95% CI 1.83-8.47).

Subgroup analyses revealed that the impact of age may depend heavily on the specific age threshold used for classification. When using an age cut-off of 70 years, the data indicated a significantly increased risk for both overall complications (OR 1.26, 9SS CI 1.03-1.55) and major complications (OR 1.95, 95% CI 1.15-3.31) in the elderly group. Conversely, when the age cut-offs were set at 60 or 65 years, no significant differences in overall or major complications were observed between the elderly and non-elderly cohorts.

Regarding safety and tolerability, the study focused on the incidence of overall, minor, and major complications, specifically highlighting postoperative sepsis as a serious adverse event. While the pooled data across all definitions suggested stability in many complication types, the increased risk of sepsis and the heightened risk profile for patients aged 70 years or older represent important safety considerations for the surgical team. The study does not report data on discontinuation rates or general tolerability.

These findings suggest that PCNL can be performed safely in elderly patients, as the stone-free rate and many complication profiles remain comparable to younger individuals when data are pooled across all age definitions. However, the results also indicate that overall and major complications increase progressively with advancing age, particularly among patients aged 70 years and older. This highlights a potential shift in the risk-benefit ratio as patients move into older age brackets.

It is important to note that this study is a meta-analysis of observational and comparative studies, meaning it reports associations rather than direct causation. The certainty of the evidence was not explicitly reported in the provided data. Clinical decisions should be based on the specific age-related risks identified, particularly the increased risk of sepsis and major complications in the oldest subgroup. Further research is needed to determine the specific clinical drivers of the increased sepsis risk in this population.

Imagine waking up with severe pain in your side. You know you need to get those stones out. Now imagine being told that your age might stop you from getting the best treatment. This fear is common among older adults and their families.

Doctors often worry that older bodies cannot handle surgery well. They think recovery will be too hard. But new data suggests this worry might be misplaced.

The Old Fear About Age

For a long time, doctors used age as a simple line in the sand. If you were over sixty-five, you might get a different treatment plan. Surgeons often chose less invasive options just because of the number on your birth certificate.

This approach ignored the actual health of the patient. It treated age like a disease instead of a number. Many older people are very fit and active. They do not feel old. Yet they faced barriers because of their age.

What Changed This Time

But here is the twist. A massive new review looked at thousands of patients. They found that age alone does not predict failure. The surgery works well for older people. The key is how the team manages the patient before and after the procedure.

The researchers compared two groups. One group was younger. The other group was older. They looked at many different definitions of old. Some said sixty. Others said sixty-five. And some said seventy.

How The Body Handles It

Think of your immune system like a security guard. It patrols your body to catch invaders. Infection is a big enemy after surgery. Older security guards sometimes slow down. They do not react as fast to new threats.

This is why infection is the main worry. The stones themselves are not the problem. The body fighting off germs is the challenge. The surgery removes the stones. The real work happens in keeping the wound clean.

The Study Details

The team gathered data from seventeen different studies. They looked at over forty-five thousand patients. More than ten thousand were in the older group. They checked for any problems after the operation. They also checked if the stones were gone.

The results were clear. The stones were removed just as well in both groups. Success rates were the same. The overall number of complications did not differ much. But one specific problem stood out.

The Infection Risk

The older group faced a higher risk of sepsis. Sepsis is a severe infection that can spread through the blood. The odds were nearly four times higher in the older group. This number jumped when patients were over seventy.

Doctors must be extra careful with these patients. They need to watch for fever and other signs of infection. Early treatment is vital. A small sign of trouble must be acted on quickly.

This doesn't mean this treatment is available yet.

The study shows what is possible in research settings. It does not mean every hospital can do this today. Some places lack the right equipment or staff. You must talk to your doctor about local options.

If you are older and have kidney stones, do not give up hope. You deserve the best care. Ask your doctor if you are a candidate for this surgery. Discuss the risks and benefits openly.

Your health history matters more than your age. If you are active and healthy, you might be a good candidate. The team will plan a safe path for you.

The Limits Of The Data

We must be honest about the limits. The studies included many different types of patients. Some were very healthy. Others had many other health issues. This mix makes the results hard to apply to one person.

Also, the data comes from many places. Each hospital has different ways of doing things. This makes it hard to say exactly what will happen in your case.

What Happens Next

More research is coming. Scientists will look at specific ways to lower infection risk. They might find new drugs or better cleaning methods. These changes could make surgery safer for everyone.

Until then, the message is clear. Age is not a barrier. Careful planning is the key. Talk to your doctor about your options. You can take control of your health today.

Study Details

Study typeMeta analysis
Sample sizen = 45,603
EvidenceLevel 1
Follow-up840.0 mo
PublishedMay 2026
View Original Abstract ↓
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.
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