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Background <p>The 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.</p> Methods <p>A 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).</p> Results <p>Eight 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; <i>p</i> = 0.02). RIRS was associated with lower odds of overall complications (OR 0.54, 95% CI: 0.37–0.80; <i>p</i> = 0.002), minor complications (OR 0.65, 95% CI: 0.43–0.98; <i>p</i> = 0.04), major complications (OR 0.30, 95% CI: 0.12–0.74; <i>p</i> = 0.008), and blood transfusion (OR 0.14, 95% CI: 0.04–0.49; <i>p</i> = 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; <i>p</i> &lt; 0.001).</p> Conclusions <p>In 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.</p>

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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

  • 期刊论文

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  • 发表日期：

    2026年6月26日

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  • Łukasz Nowak,
  • Wojciech Krajewski,
  • Klaudia Żywot,
  • Begoña Ballesta Martinez,
  • Amelia Pietropaolo,
  • Wojciech Tomczak,
  • Jan Łaszkiewicz,
  • Matthias Boeykens,
  • Thomas Tailly,
  • Theodoros Spinos,
  • Alberto Olivero,
  • Agata Góral,
  • Adam Chełmoński,
  • Bartosz Małkiewicz,
  • Bhaskar Somani,
  • Tomasz Szydełko

摘要

Background

The 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.

Methods

A 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).

Results

Eight 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).

Conclusions

In 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.