Age-dependent predictive limitations of the MAP score in standard percutaneous nephrolithotomy.

The Mayo Adhesive Probability (MAP) score, based on preoperative computed tomography, has been proposed as a predictor of complications following percutaneous nephrolithotomy (PCNL). However, the modifying effect of patient age on this association remains unclear. This study aimed to evaluate the age-dependent predictive performance of the MAP score for key postoperative outcomes in patients undergoing standard PCNL for renal stones ≥ 2 cm. A total of 417 patients were retrospectively analyzed and stratified into three age groups: Group 1 (20–39 years), Group 2 (40–59 years), and Group 3 (60–79 years). Associations between MAP score (categorized as < 3 or ≥ 3) and postoperative complications, including significant hemoglobin decline (≥ 2 g/dL) and fever (> 38 °C), were assessed within and across age groups. In the overall cohort, MAP score ≥ 3 was significantly associated with both hemoglobin drop (OR: 4.664, p < 0.001) and postoperative fever (OR: 4.301, p < 0.001). These associations remained significant in patients under 60 years of age, but not in those aged 60 or older (p = 0.574 and p = 0.549, respectively). These findings suggest that while the MAP score may serve as a useful tool for perioperative risk stratification in younger patients, its predictive capacity may be attenuated in older individuals due to the increasing influence of comorbidities and age-related physiological changes. Age-specific considerations should therefore be integrated into preoperative assessment protocols to optimize surgical planning and outcomes.