Background: This study aims to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) between patients aged 65 years and older and younger patients.

Methods: In this retrospective study, we analysed the medical records of patients who underwent RIRS for the management of the proximal ureter and renal stones between September 2022 and December 2023. The patients were divided into two age-based groups. We compared demographic and clinical data including stone-free rates (SFRs), complication rates and the necessity for secondary procedures between the two cohorts. Postoperative complications were categorised using the Clavien–Dindo classification system.

Results: A total of 258 patients were included in the study. Group 1 comprised 193 patients (74.8%) aged younger than 65 years, with an average age of 47 ± 12.3 years. Group 2 included 65 patients (25.2%) aged 65 years and older, with an average age of 68 ± 6.5 years (p-value = 0.0001). The older group had higher prevalence of comorbidities and scores based on American Society of Anaesthesiologists (ASA) guidelines compared with the younger group (p = 0.0001). Despite these differences, no statistically significant difference was observed between the two groups regarding SFR (p = 0.543) and Clavien–Dindo complication rates (p = 0.659). Both groups demonstrated similar rates of postoperative complications and required secondary procedures at similar rates.

Conclusions: RIRS provides similar efficacy and safety in patients aged 65 years and older compared with younger patients. Further studies with larger cohorts and longer follow-up periods are recommended to validate these findings.