TOPLINE:

A multicentre study evaluating clinical outcomes and complications related to ureteroscopy (URS) in patients aged 80 years or older with stone disease found a 70% stone-free rate (SFR) for zero fragments, with the rate rising to 90% when fragments measured 2.1-4 mm. The overall complication rate was 16%, with major complications occurring in 2.8% of cases.

METHODOLOGY:

• Researchers conducted a retrospective analysis involving 679 patients aged 80 years or older who underwent URS for stone disease between January 2014 and December 2024 at 20 centres in 14 countries spanning Asia, Europe, and North America.
• The median cumulative stone size was 11 mm (IQR, 7-15), and 56% of patients had a single stone. The primary outcome was SFR, categorised as zero fragments, fragments measuring 2 mm or smaller, and fragments measuring 2.1-4.0 mm.
• The secondary outcome was the incidence of postoperative complications within 30 days of surgery, graded using the modified Clavien-Dindo (CD) system.
• The American Society of Anesthesiologists (ASA) grade was assessed before URS, and nearly half of the patients (51.4%, n = 349) were ASA grade 2; most URS procedures were performed in an elective setting (94.5%, n = 642) and under general anaesthesia (77.3%, n = 525).
• Researchers used multivariable logistic regression to identify predictors of postoperative complications.

TAKEAWAY:

• The SFR varied by fragment size: 70% for zero fragments, 84% for fragments measuring 2 mm or smaller, and 90% for fragments measuring 2.1-4.0 mm; the SFR for zero fragments varied significantly by location: 78% for the ureter, 68% for the kidney, and 51% when both locations were involved (P < .001).
• The overall postoperative complication rate was 16%, with a 13.2% minor complication rate (CD grade 2 or less) and a 2.8% major complication rate (CD grade 3 or higher); major complications included one procedure-related death due to sepsis.
• The multivariable analysis identified an ASA score of 3 or higher (odds ratio [OR], 1.60; P = .03), operative time longer than 60 minutes (OR, 1.73; P = .01), and emergency surgery (OR, 2.96; P = .02) as independent predictors of complications.

IN PRACTICE:

"Ureteroscopy can be performed in patients aged 80 years and above with a low risk of major complications and acceptable stone clearance rates. Avoiding both emergency surgery and prolonged operative times can help reduce the morbidity profile," the authors wrote.

"The decision to operate requires careful consideration and made on a case-by-case basis," they emphasised.

SOURCE:

The study was led by Lazaros Tzelves, affiliated with the National and Kapodistrian University of Athens, Greece, and a member of the Young Academic Urologists and European Association of Urology endourology groups. It was published online on November 18 in Urolithiasis.

LIMITATIONS:

The study was limited by its retrospective nature, the heterogeneity in preoperative and postoperative imaging protocols, and the absence of data on stone volume. Information on causes of death and rates of elective reoperation was unavailable. The variation in follow-up imaging methods reflected differences in healthcare systems, resource availability, and cost considerations across participating centres, with plain radiography costing significantly less than non-contrast CT.

DISCLOSURES:

Open access funding was provided by the University of Bergen (including Haukeland University Hospital). One author received funding support from the Norwegian Institute of Urology to conduct research on urological diseases in older adults. The other authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.