Talyshinkii A. et al., 2026: . Epidemiology, diagnosis, and surgical management of urolithiasis in older adults: overview from EAU endourology.

Talyshinkii A, Ergül RB, Somani BK, Juliebø-Jones P.
Curr Opin Urol. 2026 Apr 30. doi: 10.1097/MOU.0000000000001403. Epub ahead of print.

Abstract

Purpose of review: Population ageing is changing everyday urological practice. The number of older adults is increasing, and urology already treats a patient population that is, on average, older than the general population. Consequently, older adults with urolithiasis represent a core part of contemporary endourological practice. Given this, a focused review of the available evidence is valuable to inform clinical practice.

Recent findings: A peak in stone disease can occur in older adults who may also be less likely to present with the classical features of renal colic. As such, delayed or missed diagnosis may carry greater clinical consequences. Although the literature remains relatively limited, ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy remain feasible options in appropriately selected older adults. In this group in particular, broader health associations merit consideration, as the presence of urolithiasis in older adults may reflect overall health status in later life.

Summary: The burden of urolithiasis in older adults is increasing and now represents a routine component of everyday clinical practice. Clinical presentation may differ from that seen in younger "index" patients, and complications may have a greater impact on recovery and function. Management should therefore be individualized, taking into account comorbidity, frailty, functional status, and the patient's own priorities.

Comment Hans-Göran Tiselius

This article deals with surgical treatment of stones in elderly patients. This is an interesting group of patients who sometimes present with atypical symptoms.

Old patients have a fragility, multi-morbidity and poly-pharmacology. It is mandatory that special attention is paid to the different variables commonly encountered in old persons.

There is no surprise that the authors of this article suggest URS as the method of choice. In the reviewer’s experience, however, SWL is an excellent non-invasive, non-anaesthesia requiring procedure that can be used in an individualised adapted way in which care is taken to the various medical problems.

It is noteworthy that despite a slightly lower fragment clearance, treatment without anaesthesia and with least invasiveness is the best guarantee for uneventful stone removal.

Hans-Göran Tiselius