Introduction: Electrocardiograph (ECG) is an important screening tool used to identify significant ECG changes that may alter perioperative management. Objective: To find out the pattern of ECG changes in the elderly urology patients during the pre-operative review in a tertiary centre. Study design and method: This was a prospective study of elderly urology patients recruited consecutively at the urology clinic during the pre anaesthetic review over a period of one year. Result: ECG recordings from 60 elderly patients with age ranged 65-87 years and mean age 70.84 ± 5.58 years were studied. Thirty percent of patients had normal ECG while 70% had abnormal ECG. Hypertension and diabetes mellitus were the two common intercurrent medical diseases in this study.