Work

Radiologically Measured Renal Pelvis Urine Density Is Associated with Severe Infectious Complications After Ureteroscopy for Ureteral Stones: A Post Hoc Analysis of a Multicenter Prospective Study

Year: 2025

Type: article

Abstract: This multicenter prospective study establishes, for the first time, a significant positive association between elevated renal pelvis urine density (measured in Hounsfield units [HUs]) and severe infectious complications (eg, systemic inflammatory response syndrome, urosepsis, and septic shock) following ureteroscopy in patients with ureteral stones and asymptomatic hydronephrosis. After adjusting for patient and stone characteristics, each 1 HU increase in renal pelvis urine density was associated with a 54% higher risk of complications (adjusted odds ratio [OR] = 1.54; 95% confidence interval [CI]: 1.37–1.73, p < 0.001). Additionally, gender (female vs male, adjusted OR = 3.55; 95% CI: 1.57–8.02; p = 0.002), hydronephrosis grade (G3 or G4 vs G1 or G2, adjusted OR = 4.86; 95% CI: 1.89–12.5; p = 0.001), and mean stone density (lower vs higher, adjusted OR = 0.996; 95% CI: 0.994–0.997; p < 0.001) were also independently associated with complications. This study demonstrates a positive linear association between renal pelvis urine HU values and severe infectious complications after ureteroscopy, independent of comprehensive patient and stone characteristics. Finding reliable and easy-to-obtain indicators of severe infectious complications after ureteroscopy represents a major clinical need. This study aimed to assess the association between Hounsfield units (HUs) in renal pelvis urine and severe infectious complications in patients with ureteral stones and asymptomatic hydronephrosis following ureteroscopy. In this post hoc analysis of a multicenter prospective trial, renal pelvis urine density (RPUD) was measured via non–contrast-enhanced computed tomography. Severe complications (septic shock, urosepsis, and systemic inflammatory response syndrome) were recorded. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by multivariable logistic regression. Among 601 patients, 9.5% (57/601) developed severe infectious complications. After adjustment, each one HU unit increase in RPUD was associated with 54% higher odds of severe infectious complications (adjusted OR = 1.54; 95% CI: 1.37–1.73; p < 0.001). Restricted cubic splines confirmed a linear relationship (nonlinear p = 0.2). Gender (female vs male, adjusted OR = 3.55; 95% CI: 1.57–8.02; p = 0.002), hydronephrosis grade (G3 or G4 vs G1 or G2, adjusted OR = 4.86; 95% CI: 1.89–12.5; p = 0.001), and mean stone density (lower vs higher, adjusted OR = 0.996; 95% CI: 0.994–0.997; p < 0.001) were also independently associated with severe infectious complications. This study demonstrates a positive linear association between renal pelvis urine HU values and severe infectious complications after ureteroscopy, independent of comprehensive patient and stone characteristics. We found that higher urine density in the renal pelvis (measured by a computed tomographic scan) is significantly associated with the incidence of severe infectious complications after ureteroscopy for ureteral stones.

Source: European Urology Open Science

DOI: 10.1016/j.euros.2025.09.002