Safety and Efficacy of Flexible Ureteroscopy for Renal Stone Disease in Elderly Patients: A Scoping Review

Background: The global incidence of urolithiasis is increasing, with a growing proportion of cases occurring in elderly patients. Flexible ureteroscopy (fURS) is an established minimally invasive treatment for renal stones; however, concerns persist regarding its safety and effectiveness in older populations with higher comorbidity burdens. This scoping review aims to evaluate the current evidence on the safety and efficacy of fURS in elderly patients, with a specific focus on perioperative complications, postoperative recovery, and long-term outcomes. Methods: A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A systematic literature search of PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials was performed from database inception to 26 November 2025. Observational and experimental studies evaluating outcomes of fURS in elderly patients were included. Data were synthesized descriptively. Results: Fourteen studies met the inclusion criteria, comprising predominantly retrospective cohort analyses and large registry-based studies. Definitions of elderly patients varied across studies (≥65 to ≥80 years). Elderly patients consistently exhibited higher comorbidity burdens and ASA scores than younger cohorts. Intraoperative complications were uncommon (<5%) and largely independent of age. Overall postoperative complication rates ranged from 12% to 18%, with the majority being low grade (Clavien–Dindo I–II). Major complications (Clavien–Dindo ≥III) were rare, generally occurring in fewer than 5% of cases. Stone-free rates were comparable between elderly and non-elderly patients. Long-term outcomes, including renal function preservation, stone-event-free survival, and late complications, were favorable and not significantly influenced by age. Conclusions: Current evidence indicates that fURS is a safe and effective treatment option for renal stone disease in elderly patients. Chronological age alone should not be considered a contraindication to ureteroscopic stone surgery. Careful patient selection, perioperative optimization, and procedural efficiency remain critical determinants of outcomes.