SynthesisBMC geriatrics2026
Safety and effectiveness of retrograde intrarenal surgery versus percutaneous nephrolithotomy in older patients: a systematic review and meta-analysis by the EAU-YAU urolithiasis and EAU endourology sections.
Synthesis in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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16 authors.
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Abstract
backgroundThe comparative efficacy and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) have been extensively evaluated in the general adult population; however, evidence specifically focused on older patients remains limited. Given the underrepresentation of older individuals in comparative studies and the lack of age-specific meta-analytic data, we conducted a systematic review and meta-analysis to evaluate and compare the efficacy and safety of RIRS versus PCNL in the geriatric population.
methodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of RIRS and PCNL in older patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to January 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to the age thresholds used to define the geriatric population (≥ 60 and ≥ 65 years).
resultsEight studies including 849 older patients (419 RIRS, 430 PCNL) were analysed. PCNL was associated with a significantly higher final SFR (OR 0.63, 95% CI: 0.43-0.93; p = 0.02). RIRS was associated with lower odds of overall complications (OR 0.54, 95% CI: 0.37-0.80; p = 0.002), minor complications (OR 0.65, 95% CI: 0.43-0.98; p = 0.04), major complications (OR 0.30, 95% CI: 0.12-0.74; p = 0.008), and blood transfusion (OR 0.14, 95% CI: 0.04-0.49; p = 0.002). No significant differences were observed in postoperative fever or sepsis. Operative time did not differ significantly, whereas hospital stay was significantly shorter following RIRS (MD - 2.0 days, 95% CI: -2.6 to - 1.3; p < 0.001).
conclusionsIn older adults, PCNL was associated with higher stone clearance rates, whereas RIRS showed a more favourable safety profile and shorter hospitalisation. Treatment selection should balance efficacy against perioperative morbidity.
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