Ureteroscopy for stone disease in the elderly. is it safe and effective? A systematic review and meta-analysis

Rising life expectancy has led to a growing number of elderly individuals requiring urological care. Ureteroscopy (URS), a first-line surgical treatment for urinary stones < 2 cm, presents unique challenges in this population, where evidence remains limited. This meta-analysis sought to evaluate the safety and efficacy of URS for urolithiasis in elderly patients compared to a younger cohort.

We systematically searched PubMed, Embase, and Cochrane databases for studies comparing URS outcomes between elderly and younger patients. Studies were stratified based on age cutoffs for older individuals, with five primary cutoffs employed for subgroup analysis: ≥ 60, ≥ 65, ≥ 75, ≥ 80, and ≥ 85 years old. Primary outcomes included stone-free rate (SFR) and minor and major complications. Secondary outcomes were operative time (OT), length of stay (LOS), and reintervention rates.

Fourteen studies encompassing 7,664 patients were included. No significant differences were observed between groups in SFR (OR 1.03 [95%confidence interval [CI] 0.86-1.23], p = 0.72), minor (OR 1.23 [95%CI 0.87-1.76], p = 0.22) or major complications (OR 1.41 [95%CI0.85-2.32], p = 0.18). While elderly patients experienced a longer LOS (MD 0.97 [95%CI0.09-1.84], p = 0.03), OT and reintervention rates were comparable between groups.

URS appears to be a viable treatment option for elderly patients deemed suitable for active stone management. The procedure did not increase the risk of minor or major complications, and provided equivalent SFR, although longer LOS may be expected in this population. Future research with standardized elderly definitions and extended follow-up is essential to better delineate the role of URS in this demographic.