Risk factors for postoperative febrile urinary tract infection in patients with urolithiasis: a meta-analysis.

Abstract

<h4>Objective</h4>To identify risk factors for febrile urinary tract infection (FUTI) following surgical intervention for urinary stones.<h4>Methods</h4>We systematically searched seven databases (from CNKI to EMBASE) from inception to May 2025 for cohort and case-control studies investigating risk factors for FUTI. Two investigators independently screened studies, extracted data, and assessed quality (Newcastle-Ottawa Scale). Adjusted odds ratio (OR) with 95% confidence interval (CI) were used as effect measures. Meta-analysis was performed using Stata 12.0.<h4>Results</h4>16 studies (<i>n</i> = 5,366) revealed FUTI incidence of 17% (95%<i>CI</i>:12.6-21.3%). Ten significant risk factors were identified: (1) General factors: Stone size (<i>OR</i> = 1.29, 95%<i>CI</i>:1.09-1.52) and operative duration (<i>OR</i> = 1.05, 95%<i>CI</i>:1.01-1.10). (2) Comorbidity: Diabetes (<i>OR</i> = 2.18, 95%<i>CI</i>:1.65-2.87), Renal insufficiency (<i>OR</i> = 3.19, 95%<i>CI</i>:2.16-4.70). (3) Preoperative: preoperative hydronephrosis (<i>OR</i> = 2.33, 95%<i>CI</i>: 1.14-4.76), elevated preoperative procalcitonin (<i>OR</i> = 1.08, 95%<i>CI</i>: 1.03-1.13), preoperative pyuria (<i>OR</i> = 4.05, 95%<i>CI</i>:1.88-8.74), preoperative bacteriuria (<i>OR</i> = 2.45, 95%<i>CI</i>: 2.07-2.90), perinephric fat stranding (<i>OR</i> = 5.09, 95% <i>CI</i>:1.71-15.14), and tissue margin sign (<i>OR</i> = 2.84, 95%<i>CI</i>:1.91-4.23).<h4>Conclusion</h4>Diabetes mellitus, renal insufficiency, preoperative hydronephrosis, elevated procalcitonin, preoperative pyuria, preoperative bacteriuria, perinephric fat stranding, tissue rim sign, operative duration, and stone size are potential independent predictors of FUTI after urinary stone surgery. These findings enable targeted prevention strategies for high-risk urolithiasis patients.