Perioperative frailty evaluation in geriatric urological patients: a comprehensive review

As global populations age, frailty in elderly patients undergoing urological surgery has emerged as a key perioperative concern. This review comprehensively examines frailty assessment in this context, spanning theoretical foundations, clinical evaluation, diagnostic approaches, management strategies, and unresolved challenges. The theoretical section outlines frailty definitions, underlying pathophysiological mechanisms, surgical stress impacts, and epidemiological patterns. Clinical assessment focuses on validated screening tools, functional status evaluation, and frailty's well-established association with adverse postoperative outcomes. Diagnostic advancements include emerging biomarker panels, innovative imaging techniques, and multidisciplinary assessment models. Therapeutic interventions analyze evidence-based approaches including prehabilitation protocols, targeted nutrition support, and postoperative rehabilitation programs. Key controversies address the lack of standardized assessment criteria, diagnostic overlap with other geriatric syndromes, and limited long-term outcome data. Future directions highlight the potential of artificial intelligence-enhanced tools, personalized risk stratification systems, and integrated care pathways. By synthesizing current evidence and identifying knowledge gaps, this review provides a framework for optimizing perioperative care of frail elderly urological patients while guiding future research priorities in this rapidly evolving field.