Caglar Ufuk, Dizdaroglu Caglar, Yusuf Resit, Aksu Ufuk Can, Ayranci Ali, Sarilar Omer, Ozgor Faruk
Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
J Endourol. 2025 Mar;39(3):231-236. doi: 10.1089/end.2024.0578. Epub 2025 Feb 5.
Renal pelvis urine density (RPUD), as measured by computed tomography (CT), may serve as an effective predictor for pyonephrosis. Our objective was to evaluate the correlation between the likelihood of developing infectious complications post-retrograde intrarenal surgery (RIRS) and RPUD measurements obtained from preoperative CT scans. We retrospectively reviewed data from patients who underwent RIRS for kidney stone treatment at a tertiary care facility between June 2017 and June 2024, using the hospital's database. The patients were divided into two groups based on the development of postoperative infective complications. The groups were compared in terms of preoperative (demographic data, stone characteristic, and RPUD) and operation data. RPUD was measured by creating an ellipse much as possible area encompassing the renal pelvis on the treated side area encompassing the renal pelvis on the treated side, and the average Hounsfield unit (HU) value was recorded. Postoperative infection developed in 31 of 588 patients (5.3%). The median RPUD value was 15 in the infective group and 8 in the noninfective group, with a statistically significant difference between the groups ( = 0.001). Body mass index, stone burden, stone density, and RPUD were associated with postoperative infection in the multivariate analysis ( = 0.001, = 0.008, = 0.007, and = 0.001, respectively). Each unit increase in RPUD increased the risk of postoperative infection 1.107-fold. The receiver operating characteristic (ROC) analysis demonstrated a significant relationship between RPUD value and the risk of postoperative infection, with an area under the curve of 0.742 ( = 0.001). When the RPUD cut-off value was accepted as 14, sensitivity was 0.613 and specificity was 0.779. This study showed a significant association between HU values in RPUD and the risk of infectious complications following RIRS. This finding suggests that incorporating urine HU values from CT images into preoperative risk assessment could be crucial for infection prevention and management.
通过计算机断层扫描（CT）测量的肾盂尿液密度（RPUD）可作为肾积脓的有效预测指标。我们的目的是评估逆行性肾内手术（RIRS）后发生感染并发症的可能性与术前CT扫描获得的RPUD测量值之间的相关性。我们使用医院数据库，回顾性分析了2017年6月至2024年6月期间在一家三级医疗机构接受RIRS治疗肾结石的患者的数据。根据术后感染并发症的发生情况将患者分为两组。比较两组的术前（人口统计学数据、结石特征和RPUD）和手术数据。通过在患侧尽可能创建一个包含肾盂的椭圆形区域来测量RPUD，并记录平均亨氏单位（HU）值。588例患者中有31例（5.3%）发生术后感染。感染组的RPUD中值为15，非感染组为8，两组之间差异有统计学意义（P = 0.001）。多因素分析显示，体重指数、结石负荷、结石密度和RPUD与术后感染相关（P分别为0.001、0.008、0.007和0.001）。RPUD每增加一个单位，术后感染风险增加1.107倍。受试者工作特征（ROC）分析显示，RPUD值与术后感染风险之间存在显著关系，曲线下面积为0.742（P = 0.001）。当RPUD临界值设定为14时，敏感性为0.613，特异性为0.779。本研究表明，RPUD中的HU值与RIRS后感染并发症的风险之间存在显著关联。这一发现表明，将CT图像中的尿液HU值纳入术前风险评估对于感染的预防和管理可能至关重要。
