Risk factors analysis of Flexible Ureteroscopic Lithotripsy with UTI and construction of clinical prediction model

Abstract

Purpose The flexible ureteroscope offers advantages such as safety, minimally invasive procedures, quick recovery, and a high rate of stone removal. It has become a standard method for treating ureteral stones as well as small and medium-sized kidney stones. UTI is one of the most common postoperative complications that can lead to sepsis, systemic inflammatory response syndrome, urological sepsis, and even septic shock. Our aim is to analyze the risk factors for UTI following ureteroscopic lithotripsy and to develop corresponding clinical prediction models. Methods A retrospective analysis was conducted on patients who underwent FURS surgery for urinary tract stones at our hospital from January 2021 to January 2023. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative infection and to develop the corresponding Nomogram prediction model. Results In total, 560 patients underwent flexible ureteroscopic lithotripsy (FURL) in our hospital, including 111 patients who developed postoperative UTI, resulting in an incidence rate of 19.8%. Analysis of the multivariate logistic regression data showed that renal dysfunction[OR = 2.103(95%CI:1.134–3.907),P = 0.018],positive preoperative urine culture [OR = 6.070(95%CI:1.800-20.474),P = 0.004], positive urinary nitrate [OR = 3.206 (95%CI: 1.599–6.429),P = 0.001],IL-6 > 5.3pg/ml[OR = 6.876(95%CI:3.734–12.661),P < 0.001],uric acid > 430 umol /L [OR = 2.024(95%CI:1.088–3.765),P = 0.026], ureteral stricture[OR = 3.174(95%CI:1.660–6.070), P < 0.001] were independent risk factors for UTI in patients after flexible ureteroscopy. The area under the ROC curve of the constructed nomogram prediction model is 0.89 (95% CI: 0.876–0.937). The concordance index reached 0.841. Conclusion Renal dysfunction, positive preoperative urine culture, positive urine nitrite, IL-6 > 5.3 pg/ml, uric acid > 430 umol/L, and ureteral stenosis were identified as risk factors for UTI after flexible ureteroscopic lithotripsy. The nomogram prediction model has high clinical value in the prediction of UTI.