Female patients with upper urinary tract stones had a higher risk of requiring a complex treatment course as a result of several factors, according to a retrospective cohort study.
In the study, researchers included 219 patients with upper urinary tract stones who underwent surgical treatment at a single center between January 2024 and May 2025. They analyzed preoperative clinical, imaging, and laboratory variables to identify predictors of treatment complexity, defined as a composite of preoperative ureteral stent placement because of infection or obstruction, three or more stone-related readmissions within 12 months, or hospital stay longer than 6 days.
In a multivariate analysis, stone location and infection were the strongest predictors of treatment complexity. Patients with renal stones had about 6.7 times the odds of treatment complexity compared with those with ureteral stones, while those with bacterial or fungal infection had 3.3 times the odds.
Higher levels of inflammatory markers were also associated with increased risk. For instance, elevated high-sensitivity C-reactive protein and procalcitonin were independently linked to treatment complexity, with risk increasing as levels rose.
Several factors weren't independently associated with treatment complexity after adjustment, including age, stone size, body mass index, metabolic comorbidities, and acute renal insufficiency.
Among patients with a complex treatment courses, prolonged hospital stay was the most common component, followed by preoperative stenting and repeated readmissions.
The researchers proposed an exploratory preoperative risk stratification framework, classifying renal stone location and bacterial/fungal infection as high-risk features and elevated inflammatory markers as intermediate risk. They noted that this framework may require external validation prior to clinical use.
The study had several limitations. It was retrospective and conducted at a single center, which may have limited generalizability. The sample size was modest, and the composite outcome combined events with different clinical implications. Infection-related variables were directly linked to one component of the outcome, which may have overestimated their predictive strength. The study also included female patients alone and lacked external validation.
“[M]ay aid in the identification of high-risk patients and offers preliminary evidence to support individualized surgical strategies and perioperative management plans,” wrote lead study author Zimei Mo, of the Yangjiang Hospital of Traditional Chinese Medicine, and colleagues.
The study authors reported no competing financial interests and no external funding.
Source: BMC Urology
