Impact of Menopausal Status on Outcomes of Prone Percutaneous Nephrolithotomy for Staghorn Stones

Background Menopause has been associated with an increased risk of kidney stone formation; however, its impact on surgical outcomes in women undergoing percutaneous nephrolithotomy (PCNL) for complex stones remains unclear. This study aimed to compare surgical success, perioperative outcomes, and complication rates between premenopausal and menopausal women undergoing percutaneous nephrolithotomy for staghorn stones. Methods Female patients who underwent prone PCNL for staghorn kidney stones between January 2024 and January 2026 were retrospectively analyzed. Patients were divided into premenopausal (n=81) and menopausal (n=75) groups. Demographic characteristics, perioperative parameters, complication rates, and residual stone outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of residual stone formation. Results A total of 156 patients were included. Age and body mass index were significantly higher in the menopausal group (p<0.001 and p=0.0003, respectively). Operative parameters, including stone burden, stone density, operative time, nephroscopy time, and fluoroscopy time, were comparable between groups. Residual stone rates were 38.3% in the premenopausal group and 22.7% in the menopausal group, with borderline statistical significance (p=0.053). In multivariable analysis, menopausal status was independently associated with a lower risk of residual stone formation (OR 0.36; 95% CI 0.15–0.82; p=0.016), while stone burden was identified as the strongest independent predictor (OR 1.08 per 100 units; 95% CI 1.02–1.13; p=0.008). Overall and major complication rates did not differ significantly between groups. Conclusions Menopausal status did not adversely affect complication rates or postoperative recovery following prone PCNL for staghorn kidney stones. Although residual stone rates were lower in menopausal patients, stone burden remained the primary determinant of surgical success. Menopause should not be considered a limiting factor for PCNL in women with staghorn stones.