Presented by: Altug Tuncel Prof.
University of Health Sciences School of Medicine, Ankara State Hospital, Department of Urology

Introduction

The widespread use of retrograde intrarenal surgery (RIRS) in upper urinary tract stone disease brings along infectious complications. In the current study we aimed to define a new scoring system for predicting febrile urinary tract infection (F-UTI) following RIRS.

Materials

We retrospectively analysed the medical records of the patients who underwent RIRS due to upper urinary tract stone disease in three different tertiary centers between January 2021 and January 2023. A total of 511 patients were included in the study and demographic, radiological and laboratory data were recorded. The patients were divided into two groups. Group 1 consisted of 34 patients who suffered postoperative F-UTI and Group 2 consisted of 477 patients who did not. A comparison between the groups was performed by using T-test and Chi-square test. We used feature selection to determine the relevant variables via Weka^® software. Consistency subset evaluator and greedy stepwise techniques were used for attribute selection. Logistic regression analysis was performed with the variables that obtained from feature selection to develop our scoring system. The accuracy of discrimination was assessed by the receiver operating characteristic (ROC) curve.

Results

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The mean age of the patients was 50.3 ± 14.4 years and the mean stone size was 15 ± 5.3 mm (Table 1). Five of 19 variables namely diabetes, hydronephrosis, administration type, previous post-ureterorenoscopy (URS) UTI history and urine leucocyte were obtained from feature selection. Binary logistic regression analysis showed that hydronephrosis (p=0.011), previous post-URS UTI history (p=0.007) and urine leucocyte (p=0.001) were significant independent predictors of F-UTI following RIRS (Table 2). These three factors showed good discrimination with the area under curve (AUC) value 0.837 (95% CI: 0.765–0.910). In the presence of at least one of these factors, 32 of 34 patients who complicated with postoperative F-UTI were successfully predicted (Table 3).  

Conclusion

Our study demonstrated that hydronephrosis, previous post-URS UTI history and urine leucocyte are significant predictors of infectious complications following RIRS. In addition, this scoring system that we develop based on these factors can successfully discriminate the patients that complicated with F-UTI after RIRS. Our results need to be confirmed with further studies.

Funding

None

Lead Authors

Cagdas Senel, MD
Balıkesir University School of Medicine, Department of Urology

Co-Authors

Cagdas Senel, MD
Balıkesir University School of Medicine, Department of Urology

Anil Erkan, MD
University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology

Tanju Keten, MD
University of Health Sciences School of Medicine, Ankara State Hospital, Department of Urology

Ibrahim Can Aykanat, MD
Koc University School of Medicine, Department of Urology

Ali Yasin Ozercan, MD
Ministry of Health, Sirnak State Hospital, Department of Urology

Koray Tatlici, MD
University of Health Sciences School of Medicine, Ankara State Hospital, Department of Urology

Serdar Basboga, MD
University of Health Sciences School of Medicine, Ankara State Hospital, Department of Urology

Sinan Saracli, Prof.
Balıkesir University School of Medicine, Department of Biostatistics

Ozer Guzel, Prof.
University of Health Sciences School of Medicine, Ankara State Hospital, Department of Urology

Altug Tuncel, Prof.
University of Health Sciences School of Medicine, Ankara State Hospital, Department of Urology