The Role of Renal Pelvis Urine Attenuation Value in Forecasting Infection Risk After Mini-Percutaneous...

Area of Science:

• Urology
• Radiology
• Infectious Diseases

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
• Infectious complications can arise post-PCNL, impacting patient outcomes.
• Predictive markers for these complications are crucial for optimizing patient care.

Purpose of the Study:

• To determine if preoperative renal pelvis urine density (RPUD), measured via computed tomography (CT), can predict infectious complications after PCNL.
• To assess the diagnostic accuracy and reliability of RPUD as a predictive marker.

Main Methods:

• Retrospective analysis of 226 patients undergoing PCNL with sterile preoperative urine cultures.
• Measurement of RPUD on noncontrast CT scans by two independent urologists.
• Comparison of variables between patients with and without postoperative infectious complications, using logistic regression and ROC analysis.

Main Results:

• Patients with postoperative infections exhibited significantly higher RPUD values (13.7 vs. 6.0 HU, P=.001) and longer operative times (70 vs. 50 min, P=.001).
• RPUD (OR: 1.238) and operative time (OR: 1.055) were identified as independent predictors of infection.
• An RPUD cutoff of 9.250 demonstrated 80.0% sensitivity and 80.1% specificity for predicting infection (AUC: 0.875).
• Excellent interobserver reliability for RPUD measurement was observed (ICC: 0.942).

Conclusions:

• Preoperative RPUD is a dependable, noninvasive radiological marker for predicting infectious complications following PCNL.
• Routine RPUD measurement can enhance preoperative risk stratification and perioperative management.
• Further validation in prospective, multicenter studies is recommended.