Objectives. To evaluate the success and morbidity of percutaneous neph
rolithotomy (PNL) performed in patients aged 65 years and older. Metho
ds. A retrospective review of 42 PNLs performed on 33 patients aged 65
years and older was compared with a cohort of 160 PNLs performed on y
ounger patients over the same time period. Results. The presence of co
mplete staghorn calculi (17 of 36 renal units [47%] versus 88 of 160 r
enal units [55%], p = 0.46) and average stone size (3.8 cm versus 4.3
cm, p = 0.2) were similar for the 2 groups. Eighty-two percent of pati
ents (27 of 33) were stone-free or left with fragments < 5 mm at 3 mon
ths after surgery. Elderly patients had a higher transfusion rate afte
r PNL despite similar preoperative hemoglobin levels (11 of 42 PNLs [2
6%] versus 22 of 160 PNLs [14%], p < 0.01). Serious complications were
infrequent and there were no deaths. Conclusions. Percutaneous nephro
lithotomy is a safe and effective therapy for elderly patients with co
mplex stone disease; however, awareness of an apparent increased requi
rement for blood transfusion is warranted.