Risk factors for systemic inflammatory response syndrome after endoscopic lithotripsy for upper urinary calculi

To explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi.

This retrospective study included patients with upper urinary calculi who underwent endoscopic lithotripsy in the First Affiliated Hospital of Zhejiang University between June 2018 and May 2020.

A total of 724 patients with upper urinary calculi were included. One hundred and fifty-three patients developed SIRS after the operation. The occurrence of SIRS was higher after percutaneous nephrolithotomy (PCNL) compared with ureteroscopy (URS) (24.6% vs. 8.6%, P < 0.001) and after flexible ureteroscopy compared with ureteroscopy (fURS) (17.9% vs. 8.6%, P = 0.042). In the univariable analyses, preoperative infection history (P < 0.001), positive preoperative urine culture (P < 0.001), history of kidney operation on the affected side (P = 0.049), staghorn calculi (P < 0.001), stone long diameter (P = 0.015), stone limited to the kidney (P = 0.006), PCNL (P = 0.001), operative time (P = 0.020), and percutaneous nephroscope channel (P = 0.015) were associated with SIRS. The multivariable analysis showed that positive preoperative urine culture [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.18-4.24, P = 0.014] and operative methods (PCNL vs. URS, OR = 2.59, 95% CI: 1.15-5.82, P = 0.012) were independently associated with SIRS.

Positive preoperative urine culture and PCNL are independent risk factors for SIRS after endoscopic lithotripsy for upper urinary calculi.