Akgül Murat, Özman Oktay, Başataç Cem, Çakır Hakan, Çınar Önder, Şahin Mehmet Fatih, Şimşekoğlu Fatih, Teke Kerem, Sıddıkoğlu Duygu, Yazıcı Cenk Murat, Sancak Eyüp Burak, Başeskioğlu Barbaros, Akpınar Haluk, Önal Bülent
Umraniye Training Research Hospital, Clinic of Urology, Health Sciences University, İstanbul, Turkey.
Memorial Health Group Hospital, Clinic of Urology, Istanbul, Turkey.
World J Urol. 2025 Jan 2;43(1):55. doi: 10.1007/s00345-024-05413-3.
Postoperative fever (POF)/urinary tract infection (UTI) is one of the most unpleasant and undesirable conditions for surgeons after retrograde intrarenal surgery (RIRS). RIRS is not recommended for any patient with a positive urine culture to avoid POF and UTI, but some patients may develop postoperative UTI even if the urine culture is sterile. This study investigated the predictive factors of fever and UTIs after RIRS.
In total, 1240 patients who underwent RIRS for proximal ureteral stones and/or kidney stones were analyzed. After case-control matching, 168 patients were included in the study. Demographic data, preoperative/peroperative/postoperative data, and hematological parameters were compared. Patients with sterile urine cultures were included in the study. Postoperative fever was defined as fever ≥ 38 °C within 72 h after RIRS. Patients were divided into two groups: those with and without POF/UTI. Demographic data, preoperative and postoperative findings, and inflammatory parameters of the patients were compared retrospectively.
POF/UTI was observed in 61 (36.3%) of 168 patients who underwent RIRS. After case-control matching, increased body mass index (BMI) and longer operation time were found to be significant predictors of POF/UTI (p = 0.001 and 0.016 respectively). Preoperative systemic immune-inflammation index (SII) (PxN/L), high Platelet/Lymphocyte Ratio (PLR), and urine leukocyte positivity were found to be significant predictors of POF/UTI (p = 0.037, 0.025 and 0.038 respectively).
Hematological parameters are simple and feasible to use to evaluate POF/UTI in patients undergoing RIRS. High SII and PLR may predict POF and early infection after RIRS. In addition, according to demographic data and per-operative status, high BMI and prolonged operation time are risk factors for infection.
术后发热（POF）/尿路感染（UTI）是逆行性肾内手术（RIRS）后外科医生面临的最令人不适且不期望出现的情况之一。对于任何尿培养阳性的患者，均不建议进行RIRS以避免POF和UTI，但即使尿培养无菌，一些患者仍可能发生术后UTI。本研究调查了RIRS后发热和UTI的预测因素。
总共分析了1240例因近端输尿管结石和/或肾结石接受RIRS的患者。经过病例对照匹配后，168例患者纳入研究。比较了人口统计学数据、术前/术中/术后数据以及血液学参数。尿培养无菌的患者纳入研究。术后发热定义为RIRS后72小时内体温≥38°C。患者分为两组：发生POF/UTI的患者和未发生POF/UTI的患者。回顾性比较了患者的人口统计学数据、术前和术后检查结果以及炎症参数。
168例接受RIRS的患者中，61例（36.3%）出现POF/UTI。病例对照匹配后，发现体重指数（BMI）升高和手术时间延长是POF/UTI的重要预测因素（分别为p = 0.001和0.016）。术前全身免疫炎症指数（SII）（PxN/L）、高血小板/淋巴细胞比值（PLR）和尿白细胞阳性被发现是POF/UTI的重要预测因素（分别为p = 0.037、0.025和0.038）。
血液学参数用于评估接受RIRS患者的POF/UTI简单可行。高SII和PLR可能预测RIRS后的POF和早期感染。此外，根据人口统计学数据和术中情况，高BMI和手术时间延长是感染的危险因素。
