Robot‐Assisted Pyeloplasty in Elderly Patients: A Comprehensive Retrospective Analysis of Safety and Surgical Outcomes

OBJECTIVE: To evaluate the safety, feasibility, and surgical outcomes of robot-assisted pyeloplasty (RAP) in elderly compared with non-elderly patients for ureteropelvic junction obstruction (UPJO). METHODS: This retrospective study included 83 consecutive patients undergoing RAP between January 2017 and August 2025. Patients were stratified into elderly (≥ 65 years, n = 14) and non-elderly (< 65 years, n = 69) groups. We compared patient backgrounds, perioperative outcomes (operative/anastomosis time, blood loss, and hospital stay), and postoperative complications graded by the Clavien-Dindo classification. Success was defined as symptom resolution and/or improved diuretic renogram flow 6-12 months postoperatively. RESULTS: Mean operative time (214 ± 19 vs. 207 ± 8 min, p = 0.75), anastomosis time (50 ± 4 vs. 43 ± 2 min, p = 0.11), and estimated blood loss (13 vs. 20 g, p = 0.33) showed no significant differences between the elderly and non-elderly groups. The total complication rate did not differ significantly between the two groups (p = 0.22). Surgical success rates were 93.8% in the elderly and 97.1% in the non-elderly group (p = 0.53) over a median 18-month follow-up. CONCLUSION: RAP is a safe and effective procedure for appropriately selected elderly patients with ureteropelvic junction obstruction, demonstrating perioperative outcomes and surgical success rates largely comparable with those in younger patients.