Secondary signs on preoperative CT as predictive factors for febrile urinary tract infection after ureteroscopic lithotr
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RESEARCH ARTICLE
Open Access
Secondary signs on preoperative CT as predictive factors for febrile urinary tract infection after ureteroscopic lithotripsy Jin Woo Kim1†, You Jin Lee2†, Yun-Sok Ha3,4, Jun Nyung Lee3,4, Hyun Tae Kim1,3, So Young Chun5 and Bum Soo Kim1,3*
Abstract Background: Febrile urinary tract infection (UTI) is one of the most common complications after ureteroscopic lithotripsy (URS). We evaluated the effect of secondary signs on preoperative computed tomography (CT) for febrile UTI after URS. Methods: In total, 182 patients who underwent URS for ureteral stones from January 2013 to December 2015 were retrospectively included in this study. These patients were divided into two groups according to the presence of postoperative febrile UTI after URS. We compared the clinical factors, stone factors, and secondary signs between the groups. Predictive factors for febrile UTI after URS were analyzed using a multivariate logistic regression model. Results: Febrile UTI occurred in 26 of the 182 patients. In univariate analysis, presence of comorbid chronic kidney disease (CKD) and stone size were significantly different between UTI and non-UTI groups. Among secondary signs, presence of hydroureter, perinephric fat stranding, periureteral fat stranding, and tissue rim sign were significantly different between the groups. In multivariate logistic regression analysis, comorbid CKD, stone size, perinephric fat stranding, and tissue rim sign were independent predictive factors for febrile UTI after URS. Conclusion: This study demonstrated that secondary signs including perinephric fat stranding and tissue rim sign on preoperative CT, CKD, and stone size are independent predictive factors for febrile UTI after URS. Keywords: Urolithiasis, Ureteroscopy, Urinary tract infections, Computed tomography (CT)
Background Ureteroscopic lithotripsy (URS) is an effective and safe minimally invasive modality for the management of ureter stones. The first ureteroscopic procedure was introduced in the 1960s, and it has been currently considered as the preferred treatment modality for the management of ureter stones. However, various complications can occur after URS, of which febrile urinary tract infection * Correspondence: [email protected] † Jin Woo Kim and You Jin Lee contributed equally to this work. 1 Department of Urology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, South Korea 3 Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea Full list of author information is available at the end of the article
(UTI) is the most common complication, which can worsen with sepsis in serious cases [1]. Unenhanced helical computed tomography (UHCT) is one of the most useful imaging modalities for the diagnosis of urinary stones. UHCT provides information regarding urinary stones, including their location, sizes, number, and attenuation values, with high sensitivity (95–98%) and specificity (96–100%), as shown by previous studies [2, 3]. Since the 1990
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