Influencing Factors Of Postoperative Recurrence Of Upper Urinary Tract Calculi In Children And Adolescents

Objective :The incidence and recurrence rate of urinary calculi in children and adolescents are increasing year by year.However,there are few studies on postoperative recurrence of urinary calculi in children and adolescents.This study is to sort out the postoperative data of children and adolescents less than 18 years old to explore the influencing factors of postoperative upper urinary calculi recurrence,and to provide theoretical basis for the prevention of postoperative recurrence of urinary calculi in children and adolescents,so as to reduce the postoperative recurrence rate and improve the quality of life.Methods:A retrospective analysis was performed on patients diagnosed with upper urinary tract calculi from September 2014 to October 2022 who underwent surgical treatment and were younger than 18 years old.A total of 213 cases were collected,including 47 patients with recurrent upper urinary tract calculi and 166 patients with non-recurrent calculi.Relevant clinical data were collected and statistically analyzed by SPSS26.0.Logistic regression was used to screen risk factors,and multivariate analysis was used to evaluate the risk factors of postoperative stone recurrence in children and adolescents.Results:A total of 213 children and adolescents after upper urinary tract calculi surgery were included in this study,including 115males(54%)and 98 females(46%),with a median age of 8.0 years(IQR:3-13).Among them,59 patients(27.7%)were overweight,125 patients(58.7%)were normal weight,29 patients(13.6%)were weight loss,27 patients(12.7%)had a family history of calculi,and 50 patients(23.5%)had preoperative urinary tract infection.Among upper urinary tract calculi,89 patients(41.8%)had renal calculi,88 patients(41.3%)had ureteral calculi,and 36patients(16.9%)had renal calculi with ureteral calculi.Through a median follow-up of36 months(IQR:23.5-58),47 patients(22.1%)had postoperative stone recurrence.Logistic univariate analysis showed that preoperative urinary tract infection,high stone burden and overweight were risk factors for postoperative stone recurrence(P<0.05).Multivariate analysis showed that preoperative urinary tract infection(OR=2.866,CI:1.344-6.110),high stone burden(OR= 4.937,CI:2.240-10.881)and overweight(OR= 2.279,CI:1.056-4.918)was the risk factor of postoperative stone recurrence in children and adolescents(P<0.05).A clinical predictive model was constructed:Logit(p)=-2.869 +1.597* high stone burden +0.824* overweight body mass index +1.053* preoperative urinary tract infection.Hosmer-Lemeshow test was performed on the regression model,the chi-square value was 3.08,P=0.878>0.05,indicating that the regression model had good calibration.The ROC curve of the model was drawn,and the area under the ROC curve of the prediction model was75.5%(P< 0.001),with a sensitivity of 61.7% and a specificity of 81.3%.Conclusions:Preoperative urinary tract infection,high stone burden and overweight were risk factors for postoperative stone recurrence in children and adolescents.The clinical predictive model based on the above independent risk factors was 75.5%,sensitivity61.7% and specificity 81.3%.It has certain reference value for predicting postoperative upper urinary tract stone recurrence in children and adolescents...