Research Article
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Published Online: 1 February 2022

Assessing the Optimal Urine Culture for Predicting Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery: Results from a Systematic Review and Meta-Analysis

Publication: Journal of Endourology
Volume 36, Issue Number 2

Abstract

Background: Systemic inflammatory response syndrome (SIRS) is a dangerous complication after percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). We aimed to review the diagnostic accuracy of midstream urine culture (MSUC), pelvic urine culture (PUC), and stone culture (SC) derived from the same cases to predict SIRS after PCNL and/or RIRS.
Materials and Methods: A comprehensive literature search was performed, using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. Sensitivity and specificity were calculated for MSUC, PUC, and SC. The diagnostic odds ratio (DOR) was estimated for each study with a random effect and hierarchical summary receiver operating characteristic (HSROC) model leading to a corresponding 95% confidence interval (CI). Overall test accuracy was measured by finding the area under the curve (AUC). An AUC value >0.70 stands for adequate overall accuracy.
Results: The search retrieved 537 articles. After screening, 21 studies involving 5238 patients were included for the meta-analysis. The pooled sensitivity for MSUC was 0.322 (95% CI 0.2228–0.432), and pooled specificity 0.854 (95% CI 0.810–0.889). The DOR was low at 2.780 (95% CI 1.769–4.368), showing poor overall diagnostic accuracy. The pooled sensitivity for PUC was 0.323 (95% CI 0.224–0.440) and specificity 0.931 (95% CI 0.896–0.954). The DOR was 6.377 (95% CI 4.065–10.004), showing a mild overall diagnostic accuracy. The pooled sensitivity for SC was 0.552 (95% CI 0.441–0.658) and specificity 0.847 (95% CI 0.798–0.886). The DOR was 6.820 (95% CI 4.435–10.488), showing mild overall diagnostic accuracy. The AUC for HSROC for MSUC was 0.65, 0.73, and 0.75 for PUC and SC, respectively.
Conclusion: MSUC is a poor predictor for postoperative SIRS. PUC or SC should be collected during lithotripsy to better predict the possibility of developing postoperative SIRS after PCNL and RIRS.

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cover image Journal of Endourology
Journal of Endourology
Volume 36Issue Number 2February 2022
Pages: 158 - 168
PubMed: 34314245

History

Published in print: February 2022
Published online: 1 February 2022
Published ahead of production: 27 July 2021

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Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
Jeremy Yuen-Chun Teoh
Department of Surgery, Faculty of Medicine, S.H. Ho Urology Center, The Chinese University of Hong Kong, Hong Kong, China.
Maria Pia Pavia
Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
Eugenio Pretore
Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
Andrea Benedetto Galosi
Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
Vineet Gauhar
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.

Notes

Address correspondence to: Daniele Castellani, MD, Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Via conca 71, Ancona 60126, Italy [email protected]

Authors' Contributions

V.G.: conceptualization. V.G., M.P.P., and D.C.: article writing. D.C.: methodology and statistics. J.Y.-C.T. and A.B.G.: supervision. E.P. and L.D.: data analysis.

Author Disclosure Statement

No competing financial interests exist.

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No funding was received for this article.

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