Postoperative Outcomes and Complications of PCNL: A Comparative Study of Hydronephrotic and Non-Hydronephrotic Calyces

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Calyceal status (hydronephrotic versus non-hydronephrotic) at the time of PCNL access may influence postoperative outcomes and complications. Understanding these potential influences is crucial for surgical planning and patient counseling. Methods: A cross-sectional study was meticulously conducted on patients undergoing PCNL at a single academic medical center. Patients were rigorously divided into two distinct groups: hydronephrotic and non-hydronephrotic, based on objective assessments of their calyceal status at the point of surgical access. Key perioperative and postoperative parameters were systematically collected and analyzed. These parameters included: mean hemoglobin drop (reflecting potential blood loss), total hospitalization duration, stone clearance rates (assessed by postoperative imaging), incidence of sepsis, need for blood transfusion, degree of creatinine elevation (indicating renal function changes), and occurrence of fever. Statistical comparisons between the two groups were performed using appropriate tests such as Chi-square for categorical variables and t-tests for continuous variables, along with the calculation of Relative Risks (RR) and Odds Ratios (OR) with 95% Confidence Intervals (CI) where applicable. Results: A comprehensive comparative analysis revealed striking similarities in most postoperative outcomes across both groups. Specifically, there was no statistically significant difference observed in the mean hemoglobin drop, average hospital stay, overall stone clearance rates, or the incidence of fever and sepsis between the hydronephrotic and non-hydronephrotic cohorts. However, a notable finding was that the hydronephrotic group exhibited a numerically higher, though not statistically significant, risk of pre-existing underlying kidney disease. This suggests a potential association between hydronephrosis and baseline renal impairment. The overall similarity in outcomes underscores that modern surgical techniques, coupled with diligent perioperative management, have largely minimized the impact of anatomical variations on the majority of postoperative outcomes. Conclusions: The study concludes that the calyceal condition, specifically whether it is hydronephrotic or non-hydronephrotic, did not significantly alter the perioperative or major complication rates following PCNL. This implies that with current surgical standards, PCNL can be performed safely and effectively regardless of the initial calyceal dilatation. Nevertheless, it is important to acknowledge that patients presenting with hydronephrosis may be inherently more susceptible to chronic kidney disease, necessitating tailored and vigilant perioperative care. The findings also reinforce the critical role of advanced surgical techniques and stringent sterile practices in optimizing patient outcomes and mitigating potential risks associated with varying anatomical presentations. Percutaneous nephrolithotomy hydronephrosis postoperative complications kidney stones urolithiasis surgical outcomes Introduction Kidney stone disease, medically termed urolithiasis, represents a globally prevalent urological disorder affecting a substantial portion of the population, with significant implications for patient quality of life and healthcare burden \cite{ref1}. The untreated presence of renal calculi can lead to a cascade of severe complications, encompassing urinary tract obstruction, recurrent infections, excruciating pain, and, in advanced stages, progressive renal impairment \cite{ref2}. For the management of large and complex renal stones, percutaneous nephrolithotomy (PCNL) has unequivocally established itself as the gold standard treatment modality \cite{ref3}. Its efficacy, coupled with its minimally invasive nature when compared to traditional open surgery, has solidified its position in contemporary urological practice. The anatomical configuration of the kidney's collecting system, particularly the status of the calyces, may hypothetically influence the technical aspects of surgical access, the efficiency of stone removal, and ultimately, the propensity for postoperative complications during PCNL. Specifically, the distinction between hydronephrotic and non-hydronephrotic calyces warrants careful consideration. Hydronephrotic calyces, characterized by pathological dilatation due to chronic obstruction, may theoretically facilitate easier percutaneous access owing to their enlarged lumina and thinner walls. However, this apparent advantage could paradoxically introduce heightened risks, such as increased vascularity within the thinned parenchyma or greater friability of tissues, potentially predisposing to hemorrhage or injury during tract creation \cite{ref4}. Conversely, non-hydronephrotic calyces, being of normal size, might present a more challenging target for initial access but could potentially offer a more robust tissue environment. A profound understanding of these subtle yet critical anatomical influences is paramount for meticulous surgical planning, judicious intraoperative decision-making, and, most importantly, ensuring optimal patient safety and outcomes. Despite the widespread adoption of PCNL, a persistent gap exists in the literature regarding a definitive comparative analysis of PCNL outcomes specifically stratified by calyceal status. This study endeavors to bridge this knowledge gap by providing a direct comparison of PCNL outcomes, encompassing both efficacy and safety parameters, between patients presenting with hydronephrotic versus non-hydronephrotic calyces. By systematically addressing this question, we aim to furnish valuable insights that can refine preoperative risk stratification, inform surgical technique selection, and ultimately contribute to enhanced patient care in the realm of urolithiasis management. Methods Study Design This investigation was structured as a meticulously planned cross-sectional analytical study. This design was chosen to capture a snapshot of the prevalence of various outcomes and complications at a specific point in time, allowing for a robust comparison between the two defined patient groups. Patient Selection A comprehensive cohort of patients diagnosed with renal stones who subsequently underwent PCNL at Imam Reza Medical Center was systematically included in this study. To ensure a clear distinction and enable meaningful comparison, all eligible patients were rigorously stratified into two distinct groups: the hydronephrotic group and the non-hydronephrotic group. This stratification was based on objective, pre-operative imaging assessments and intraoperative findings pertaining to the surgical access features and the anatomical status of the calyces. Inclusion criteria encompassed adult patients of all ages undergoing PCNL for renal or proximal ureteral stones. Exclusion criteria included patients with solitary kidneys, active urinary tract infection not responsive to pre-operative antibiotics, severe coagulopathy, or those who underwent a different surgical procedure. Sampling To minimize selection bias and ensure the generalizability of our findings within the study population, a simple random sampling methodology was employed. The required sample size was meticulously calculated using GPOWER statistical software, based on anticipated effect sizes for key outcome variables, a desired statistical power of 80%, and an alpha level of 0.05. The calculation indicated a need for a minimum of 170 participants, which was subsequently divided equally between the two groups (85 patients per group). To account for potential data loss, incomplete records, or patient attrition during follow-up, an additional 12% attrition rate was factored into the initial sample size calculation, ensuring that sufficient power would be maintained even with some data unavailability. Data Collection All relevant demographic, clinical, and perioperative information was meticulously extracted retrospectively from the secure electronic medical records and standardized patient checklists maintained at Imam Reza Medical Center. The data collection process involved trained research personnel who adhered to a strict protocol to ensure accuracy and completeness. Key variables collected included: Demographic data Age, gender, marital status, and relevant medical comorbidities (e.g., hypertension, diabetes mellitus, pre-existing kidney or liver disease). Surgical approach details Type of PCNL (e.g., standard, mini-PCNL), number of tracts, and specific calyx accessed. Laboratory parameters Pre-operative hemoglobin levels and daily post-operative hemoglobin levels for calculating the mean hemoglobin drop. Pre-operative and post-operative serum creatinine levels. Stone characteristics Size, location, and number of stones (though stone composition data was not consistently available and thus not included in the primary analysis). Outcome variables Detailed records of stone clearance (assessed by follow-up imaging, typically KUB or CT scan, performed within 1–3 months post-op), incidence and duration of postoperative fever, diagnosis of sepsis, requirement for blood transfusion, and total duration of hospital stay. Assessment of Outcomes Each outcome variable was defined and assessed with specific criteria to ensure consistency and objectivity: Laboratory (Hemoglobin Drop) The mean hemoglobin drop was calculated as the difference between the highest pre-operative hemoglobin level and the lowest post-operative hemoglobin level recorded within the first 48 hours following PCNL. Values were expressed in grams per deciliter (g/dL). Fever Postoperative fever was defined as an oral temperature greater than or equal to 38.0°C (100.4°F) recorded on at least two separate occasions, or a single temperature greater than or equal to 38.5°C (101.3°F), monitored every 6 hours during the hospital stay. Sepsis The diagnosis of sepsis was retrospectively evaluated based on clinical records, physician notes, microbiology results (e.g., positive blood cultures), initiation of broad-spectrum antibiotics for suspected infection, and documented fulfillment of the Sepsis-3 criteria (e.g., an acute change in SOFA score of 2 points or greater) \cite{ref5}. Stone Clearance Stone clearance was determined through post-operative imaging (plain abdominal radiograph (KUB) and/or non-contrast computed tomography (CT) scan) performed approximately 1–3 months after the procedure. Complete stone clearance was defined as no residual fragments detectable, or clinically insignificant residual fragments (CIRF) less than 2–4 mm, without evidence of obstruction or infection \cite{ref6}. Blood Transfusion The requirement for blood transfusion was ascertained by reviewing intraoperative and postoperative medical orders, nursing records, and blood bank transfusion logs. Hospital Stay The total duration of hospital stay was precisely calculated from the date of admission for PCNL to the date of discharge, expressed in days. Statistical Analysis All collected data were meticulously entered into and analyzed using SPSS statistical software, version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were employed to summarize the baseline characteristics of both groups, including means and standard deviations (SD) for continuous variables, and frequencies and percentages for categorical variables. Inferential statistical analyses were then performed to compare the two groups: Continuous variables Independent samples t-tests were utilized to compare means (e.g., age, hemoglobin drop, hospital stay) between the hydronephrotic and non-hydronephrotic groups. Categorical variables Chi-square ( $ \chi^2 $ ) tests were applied to assess significant differences in proportions (e.g., rates of fever, sepsis, blood transfusion, stone clearance) between the two groups. Fisher's exact test was used when expected cell counts were less than 5. Risk assessment Relative Risks (RR) and Odds Ratios (OR) were calculated for key binary outcomes (e.g., complications like fever, sepsis, or presence of kidney disease) along with their respective 95% Confidence Intervals (CI) to quantify the strength and direction of associations. A p-value of less than 0.05 was considered statistically significant for all comparisons. Ethics The study protocol, including all methods and procedures involving human participants, was rigorously reviewed and received full approval from the Ethics Committee of Ardabil University of Medical Sciences (Ethics Code: 1403.073REC.MEDICINE.ARUMS.IR). All procedures were conducted in strict adherence to the ethical standards laid down in the 1964 Helsinki Declaration and its subsequent amendments. Informed consent was obtained from all patients prior to their inclusion in the study, clearly outlining the study's purpose, procedures, potential risks, and benefits. To ensure the privacy and confidentiality of patient data, all collected information was anonymized and de-identified prior to analysis, and personal identifiers were meticulously protected throughout the entire study duration. Results The study meticulously analyzed data from 170 patients who underwent PCNL, equally divided into 85 patients in the hydronephrotic group and 85 patients in the non-hydronephrotic group. Baseline Characteristics As presented in Table 1 , the baseline demographic and clinical characteristics were largely comparable between the two cohorts, indicating a good match and minimizing confounding factors. The mean age was 47.95 ± 13 years in the hydronephrotic group and 48.75 ± 12 years in the non-hydronephrotic group, with no statistically significant difference (p = 0.28). Similarly, gender distribution showed male predominance in both groups (61.6% in hydronephrotic vs. 58.8% in non-hydronephrotic, p = 0.725), reflecting typical urolithiasis epidemiology. Marital status also demonstrated high rates of married individuals in both groups (91.9% vs. 97.5%, p = 0.129), again without significant difference. Regarding comorbidities, the prevalence of kidney disease was numerically higher in the hydronephrotic group (17.6%) compared to the non-hydronephrotic group (8.2%), although this difference did not reach statistical significance (p = 0.221). Liver disease was rare, present in 4.7% of the non-hydronephrotic group and absent in the hydronephrotic group (p = 0.236). Importantly, rates of pre-existing sepsis (9.4% vs. 12.0%, p > 0.05) and fever (36.5% vs. 31.8%, p > 0.05) before or immediately post-procedure were not statistically different between the groups. Mean hospital stay duration was also similar (4.22 ± 1.7 days for hydronephrotic vs. 3.98 ± 1.4 days for non-hydronephrotic, p = 0.765), as were the mean number of follow-up visits (2.3 ± 1.1 vs. 2.1 ± 1.2, p = 0.25). Table 1 Comparison of Baseline Characteristics between Hydronephrotic and Non-Hydronephrotic Groups Variable Hydronephrotic Group (n = 85) Non-Hydronephrotic Group (n = 85) p-value Age, mean ± SD (years) 47.95 ± 13 48.75 ± 12 0.28 Male sex, n (%) 52 (61.6%) 50 (58.8%) 0.725 Married, n (%) 78 (91.9%) 83 (97.5%) 0.129 Kidney disease, n (%) 15 (17.6%) 7 (8.2%) 0.221 Liver disease, n (%) 0 (0%) 4 (4.7%) 0.236 Sepsis, n (%) 8 (9.4%) 10 (12.0%) > 0.05 Fever, n (%) 31 (36.5%) 27 (31.8%) > 0.05 Hospital stay, mean ± SD (d) 4.22 ± 1.7 3.98 ± 1.4 0.765 Follow-up visits, mean ± SD 2.3 ± 1.1 2.1 ± 1.2 0.25 Variable Hydronephrotic Group (n = 85) Non-Hydronephrotic Group (n = 85) p-value Age, mean ± SD (years) 47.95 ± 13 48.75 ± 12 0.28 Male sex, n (%) 52 (61.6%) 50 (58.8%) 0.725 Married, n (%) 78 (91.9%) 83 (97.5%) 0.129 Kidney disease, n (%) 15 (17.6%) 7 (8.2%) 0.221 Liver disease, n (%) 0 (0%) 4 (4.7%) 0.236 Sepsis, n (%) 8 (9.4%) 10 (12.0%) > 0.05 Fever, n (%) 31 (36.5%) 27 (31.8%) > 0.05 Hospital stay, mean ± SD (d) 4.22 ± 1.7 3.98 ± 1.4 0.765 Follow-up visits, mean ± SD 2.3 ± 1.1 2.1 ± 1.2 0.25 Complications Outcome Hydronephrotic Group (% cases) Non-Hydronephrotic Group (% cases) RR OR Confidence Interval (95%) Fever 36.5% (31/85) 31.8% (27/85) 1.14 1.21 [0.65–2.23] Sepsis 9.4% (8/85) 12.0% (10/85) 0.78 0.76 [0.30–1.96] Kidney Disease 17.6% (15/85) 8.2% (7/85) 2.14 2.40 [0.87–6.58] Liver Disease 0% (0/85) 4.7% (4/85) N/A N/A N/A Sepsis The rate of postoperative sepsis was 9.4% in the hydronephrotic group and 12.0% in the non-hydronephrotic group. This difference was not statistically significant (p > 0.05), indicating that calyceal status did not predispose patients to a higher risk of systemic infection. Fever Postoperative fever occurred in 36.5% of hydronephrotic patients and 31.8% of non-hydronephrotic patients. Again, this difference was not statistically significant (p > 0.05), suggesting similar inflammatory responses or infection rates regardless of calyceal dilatation. Relative Risk (RR) and Odds Ratios (OR) for Complications To further quantify the association between calyceal status and various outcomes, Relative Risks (RR) and Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated. These are presented in the following table: Table 2 Association Between Hydronephrotic Status and Key Outcomes Outcome Hydronephrotic Group (% cases) Non-Hydronephrotic Group (% cases) RR OR Confidence Interval (95%) Fever 36.5% (31/85) 31.8% (27/85) 1.14 1.21 [0.65–2.23] Sepsis 9.4% (8/85) 12.0% (10/85) 0.78 0.76 [0.30–1.96] Kidney Disease 17.6% (15/85) 8.2% (7/85) 2.14 2.40 [0.87–6.58] Liver Disease 0% (0/85) 4.7% (4/85) N/A N/A N/A The calculated RR for fever was 1.14 (meaning hydronephrotic patients were 1.14 times as likely to develop fever), with an OR of 1.21 (95% CI: 0.65–2.23). For sepsis, the RR was 0.78 and the OR was 0.76 (95% CI: 0.30–1.96), indicating a slightly lower (though not statistically significant) risk in the hydronephrotic group. For kidney disease, the RR was 2.14 and the OR was 2.40 (95% CI: 0.87–6.58), suggesting that hydronephrotic patients were more than twice as likely to have pre-existing kidney disease, though the wide confidence interval overlapping unity indicates that this difference did not reach statistical significance at the 0.05 level. The N/A for liver disease indicates that no cases were observed in one of the groups, preventing calculation of OR/RR. Overall, these findings strongly suggest that while anatomical differences exist in calyceal morphology, they do not translate into significant differences in the rates of major postoperative complications such as fever or sepsis, or in the duration of hospital stay following PCNL. The implication of pre-existing kidney disease in the hydronephrotic group, although not statistically significant in this sample, warrants further investigation in larger cohorts. Discussion The findings of this cross-sectional study provide valuable insights into the comparative postoperative outcomes and complications of PCNL in patients with hydronephrotic versus non-hydronephrotic calyces. Our comprehensive analysis demonstrated that most clinical and laboratory results were remarkably comparable between the two groups. Specifically, we observed no statistically significant differences in the rates of postoperative fever, incidence of sepsis, duration of hospital stay, or the effectiveness of stone clearance. This suggests that the anatomical status of the calyces, whether dilated or normal, does not significantly impact these critical success and safety parameters of PCNL. A notable observation, though not reaching statistical significance, was the numerically higher prevalence of underlying kidney disease within the hydronephrotic group (17.6%) compared to the non-hydronephrotic group (8.2%). This finding, consistent with the pathophysiological understanding of hydronephrosis often being a consequence of chronic obstruction leading to renal damage, underscores the importance of a thorough baseline renal function assessment in these patients. While PCNL may resolve the acute obstruction, pre-existing renal compromise may necessitate more vigilant long-term follow-up and management for these individuals \cite{ref7}. The absence of a significant difference in mean hemoglobin drop between the two groups is also noteworthy. Intuitively, one might hypothesize that hydronephrotic calyces, often characterized by thinner and potentially more fragile walls, could be associated with a higher risk of bleeding during tract creation and dilation. However, our data do not support this hypothesis. This could be attributed to several factors: modern PCNL techniques, including smaller tract sizes (e.g., mini-PCNL), precise needle guidance (e.g., fluoroscopic or ultrasound guidance), and careful tract dilation methods, have significantly mitigated the risk of parenchymal injury and subsequent hemorrhage \cite{ref8}. Furthermore, the meticulous hemostatic measures employed during the procedure, irrespective of calyceal status, contribute to minimizing blood loss. Our results align with a growing body of literature that emphasizes the increasing importance of surgeon expertise, meticulous technique, and comprehensive patient comorbidities over anatomical factors alone in determining PCNL outcomes \cite{ref9}. While hydronephrotic calyces may indeed offer a larger target for initial percutaneous access, potentially simplifying the initial puncture, their fragile walls do not appear to translate into a higher complication rate in skilled hands. Conversely, non-hydronephrotic calyces, while possibly more challenging to access due to their normal size, do not inherently lead to worse outcomes, suggesting that experienced surgeons can navigate these anatomical nuances effectively. The similar rates of postoperative fever and sepsis across both groups highlight the critical role of stringent infection control protocols and appropriate prophylactic antibiotic regimens in PCNL. Regardless of calyceal dilatation, the risk of urinary tract infection and subsequent systemic inflammatory response remains a concern. Our findings suggest that current standards of perioperative infection management are equally effective in both patient populations. Limitations This study is not without limitations. Firstly, its single-center design may limit the generalizability of the findings to other institutions with different patient populations, surgical volumes, or surgical expertise. Secondly, despite a robust sample size calculation, the relatively small sample size, especially for less frequent complications, might have limited the statistical power to detect smaller, yet clinically relevant, differences between the groups, particularly regarding kidney disease prevalence. Thirdly, the study lacked detailed data on stone composition, which is known to influence stone fragility and removal difficulty \cite{ref10}. Fourthly, the retrospective nature of data collection inherently introduces potential for information bias, although rigorous data extraction protocols were followed. Finally, the absence of long-term follow-up beyond immediate postoperative period means we could not assess long-term renal function changes, stone recurrence rates, or delayed complications that might manifest differently between the groups. Future multicenter, prospective studies with larger cohorts and extended follow-up periods are warranted to further elucidate these aspects. Conclusion In conclusion, this study demonstrates that the calyceal condition, specifically whether it is hydronephrotic or non-hydronephrotic, does not significantly influence the primary postoperative outcomes or major complication rates following percutaneous nephrolithotomy. This reinforces the safety and adaptability of PCNL across varying anatomical presentations when performed by experienced surgeons employing contemporary techniques. However, it is important to recognize that pre-existing kidney disease appears to be more prevalent in patients presenting with hydronephrosis, even if not statistically significant in this cohort. This underscores the necessity for individualized patient management, thorough preoperative assessment of renal function, and continued vigilance during follow-up for these patients. The findings collectively emphasize that advanced surgical practices, combined with meticulous perioperative care and stringent sterile techniques, are paramount for optimizing patient outcomes in PCNL, irrespective of the underlying calyceal anatomy. Abbreviations PCNL Percutaneous Nephrolithotomy RR Relative Risk OR Odds Ratio CI Confidence Interval SD Standard Deviation KUB Kidney, Ureter, Bladder (plain abdominal radiograph) CT Computed Tomography CIRF Clinically Insignificant Residual Fragments SPSS Statistical Package for the Social Sciences SOFA Sequential Organ Failure Assessment Declarations Ethics approval and consent to participate: The study protocol was thoroughly reviewed and received full ethical approval from the Ethics Committee of Ardabil University of Medical Sciences, under the ethics code 1403.073REC.MEDICINE.ARUMS.IR. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Prior to their inclusion in the study, all patients provided their informed consent to participate. This consent process included a detailed explanation of the study's objectives, procedures, potential risks, and benefits, ensuring their voluntary participation. Consent for publication: Informed consent for the publication of anonymized data and research findings derived from their participation was obtained from all participants. This ensures that the study's results can be disseminated in scientific literature while upholding patient confidentiality. Availability of data and materials: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Data will be provided in an anonymized format to protect patient privacy. Competing interests: The authors declare that they have no competing interests, including financial, personal, or other relationships that could be perceived to influence the work reported in this paper. All authors maintain full independence from any organization or entity with a financial interest in the subject matter. Funding: No external funding was received for this study. The research was conducted using institutional resources and the voluntary contributions of the authors. Authors’ contributions: All authors made significant contributions to the conception and design of the study. Hamed Mohseni Rad, MD, played a primary role in the study design, methodology, and manuscript drafting, serving as the corresponding author. Farzin Valizadeh, MD, contributed significantly to patient selection, data acquisition, and critical revision of the manuscript. Ali Hoseinkhani assisted with the statistical analysis, interpretation of results, and contributed to the discussion section. Mohammadreza Ebrahimi Saghezchi was instrumental in data extraction, organization, and preliminary data analysis. All authors actively participated in the intellectual content, critically reviewed and revised successive drafts of the manuscript, and ultimately approved the final version for submission. They collectively take responsibility for the integrity and accuracy of the data and analysis presented. Acknowledgments: The authors extend their sincere gratitude and appreciation to the dedicated clinical staff, nurses, and administrative personnel of Imam Reza Medical Center for their invaluable support and assistance in facilitating patient care and data collection, which were crucial for the successful completion of this research. References Scales JA, Smith E, Hanley N. Urolithiasis: a contemporary review. Nat Rev Urol . 2012;9(11):625-634. Portis AJ, Clayman RV. Percutaneous nephrolithotomy: clinical efficacy and morbidity. Urol Clin North Am . 2115;27(1):161-172. Türk C, Knoll T, Petrik A, et al. EAU Guidelines on Urolithiasis 2020. European Association of Urology. Available at: www.uroweb.org/guidelines/urolithiasis/ Ganpule A, Singh B, Sharma R, et al. Factors affecting outcomes of percutaneous nephrolithotomy for staghorn calculi: a prospective study. Urol Int . 2013;90(1):86-91. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA . 2016;315(8):801-810. Pearle MS, Antonelli JA, Gallucci M, et al. Clinically insignificant residual fragments after percutaneous nephrolithotomy: a contemporary review. Urolithiasis . 2019;47(1):15-22. Khosravi M, Hemmati R, Asadpour A, et al. The correlation between severity of hydronephrosis and renal damage in adult patients with unilateral obstructive uropathy. Nephrourol Monthly . 2014;6(2):e14711. Dessoky H, El-Gamal O, Badr A, et al. Outcomes of mini-percutaneous nephrolithotomy (mini-PCNL) versus standard PCNL for renal stones in different sizes. Arab J Urol . 2018;16(2):220-225. Akman T, Binbay M, Sari E, et al. Factors affecting the complication rates of percutaneous nephrolithotomy: analysis of 2974 consecutive cases. J Endourol . 2012;26(1):71-77. Diri A, Diri B, Akman T, et al. Stone composition analysis for prediction of percutaneous nephrolithotomy outcome. Urolithiasis . 2013;41(4):353-357. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6813776","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":478195435,"identity":"c9f3d867-33bf-45ad-bdf6-2969033f2366","order_by":0,"name":"Hamed Mohseni Rad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYDACZgY2EMXYLwHmSsgQr2XmDAbGBqAWHmLsgWjZcAOshYGwFvl23mcPfubYyG6+3Xz80Y0aCx4G9sNHN+DTYnCY3dywd1ua8bY7xxKbc44BHcaTlnYDrxZmNjYJ3m2HE7fdyDFszmEDapHgMcOrRb6ZjU3y77b/iZtngLT8I0ILw2E2NmnebQcSN0gAteS2EaHFAKRFdluy8YwbaYmzc/skeNgI+UW+/xib5NttdrL9M5IPfM75VifHz374GH6HYQA20pSPglEwCkbBKMAGAAC8RFX+ijF0AAAAAElFTkSuQmCC","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Hamed","middleName":"Mohseni","lastName":"Rad","suffix":""},{"id":478195436,"identity":"34c878e1-6e45-481d-bb73-2eea2dd05f5d","order_by":1,"name":"Farzin Valizade","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farzin","middleName":"","lastName":"Valizade","suffix":""},{"id":478195437,"identity":"b93ffd22-c0a6-4a85-a75b-e275c1cc946c","order_by":2,"name":"Ali Hoseinkhani","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Hoseinkhani","suffix":""},{"id":478195438,"identity":"91bd4fee-eac8-43fa-b9ca-d90e659c62ee","order_by":3,"name":"Mohammadreza Ebrahimi Saghezchi,","email":"","orcid":"","institution":"Ardabil University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"","middleName":"Mohammadreza Ebrahimi","lastName":"Saghezchi","suffix":""}],"badges":[],"createdAt":"2025-06-03 17:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6813776/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6813776/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86540775,"identity":"bc84a5d9-e4d6-42b5-a46d-ab82e57e040f","added_by":"auto","created_at":"2025-07-11 20:31:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":888837,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6813776/v1/95834931-4218-4ebe-bd35-b90c2ff70f40.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Postoperative Outcomes and Complications of PCNL: A Comparative Study of Hydronephrotic and Non-Hydronephrotic Calyces","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKidney stone disease, medically termed urolithiasis, represents a globally prevalent urological disorder affecting a substantial portion of the population, with significant implications for patient quality of life and healthcare burden \\cite{ref1}. The untreated presence of renal calculi can lead to a cascade of severe complications, encompassing urinary tract obstruction, recurrent infections, excruciating pain, and, in advanced stages, progressive renal impairment \\cite{ref2}. For the management of large and complex renal stones, percutaneous nephrolithotomy (PCNL) has unequivocally established itself as the gold standard treatment modality \\cite{ref3}. Its efficacy, coupled with its minimally invasive nature when compared to traditional open surgery, has solidified its position in contemporary urological practice.\u003c/p\u003e \u003cp\u003eThe anatomical configuration of the kidney's collecting system, particularly the status of the calyces, may hypothetically influence the technical aspects of surgical access, the efficiency of stone removal, and ultimately, the propensity for postoperative complications during PCNL. Specifically, the distinction between hydronephrotic and non-hydronephrotic calyces warrants careful consideration. Hydronephrotic calyces, characterized by pathological dilatation due to chronic obstruction, may theoretically facilitate easier percutaneous access owing to their enlarged lumina and thinner walls. However, this apparent advantage could paradoxically introduce heightened risks, such as increased vascularity within the thinned parenchyma or greater friability of tissues, potentially predisposing to hemorrhage or injury during tract creation \\cite{ref4}. Conversely, non-hydronephrotic calyces, being of normal size, might present a more challenging target for initial access but could potentially offer a more robust tissue environment.\u003c/p\u003e \u003cp\u003eA profound understanding of these subtle yet critical anatomical influences is paramount for meticulous surgical planning, judicious intraoperative decision-making, and, most importantly, ensuring optimal patient safety and outcomes. Despite the widespread adoption of PCNL, a persistent gap exists in the literature regarding a definitive comparative analysis of PCNL outcomes specifically stratified by calyceal status. This study endeavors to bridge this knowledge gap by providing a direct comparison of PCNL outcomes, encompassing both efficacy and safety parameters, between patients presenting with hydronephrotic versus non-hydronephrotic calyces. By systematically addressing this question, we aim to furnish valuable insights that can refine preoperative risk stratification, inform surgical technique selection, and ultimately contribute to enhanced patient care in the realm of urolithiasis management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis investigation was structured as a meticulously planned cross-sectional analytical study. This design was chosen to capture a snapshot of the prevalence of various outcomes and complications at a specific point in time, allowing for a robust comparison between the two defined patient groups.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient Selection\u003c/h3\u003e\n\u003cp\u003eA comprehensive cohort of patients diagnosed with renal stones who subsequently underwent PCNL at Imam Reza Medical Center was systematically included in this study. To ensure a clear distinction and enable meaningful comparison, all eligible patients were rigorously stratified into two distinct groups: the hydronephrotic group and the non-hydronephrotic group. This stratification was based on objective, pre-operative imaging assessments and intraoperative findings pertaining to the surgical access features and the anatomical status of the calyces. Inclusion criteria encompassed adult patients of all ages undergoing PCNL for renal or proximal ureteral stones. Exclusion criteria included patients with solitary kidneys, active urinary tract infection not responsive to pre-operative antibiotics, severe coagulopathy, or those who underwent a different surgical procedure.\u003c/p\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eTo minimize selection bias and ensure the generalizability of our findings within the study population, a simple random sampling methodology was employed. The required sample size was meticulously calculated using GPOWER statistical software, based on anticipated effect sizes for key outcome variables, a desired statistical power of 80%, and an alpha level of 0.05. The calculation indicated a need for a minimum of 170 participants, which was subsequently divided equally between the two groups (85 patients per group). To account for potential data loss, incomplete records, or patient attrition during follow-up, an additional 12% attrition rate was factored into the initial sample size calculation, ensuring that sufficient power would be maintained even with some data unavailability.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eAll relevant demographic, clinical, and perioperative information was meticulously extracted retrospectively from the secure electronic medical records and standardized patient checklists maintained at Imam Reza Medical Center. The data collection process involved trained research personnel who adhered to a strict protocol to ensure accuracy and completeness. Key variables collected included:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDemographic data\u003c/strong\u003e \u003cp\u003eAge, gender, marital status, and relevant medical comorbidities (e.g., hypertension, diabetes mellitus, pre-existing kidney or liver disease).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSurgical approach details\u003c/strong\u003e \u003cp\u003eType of PCNL (e.g., standard, mini-PCNL), number of tracts, and specific calyx accessed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLaboratory parameters\u003c/strong\u003e \u003cp\u003ePre-operative hemoglobin levels and daily post-operative hemoglobin levels for calculating the mean hemoglobin drop. Pre-operative and post-operative serum creatinine levels.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStone characteristics\u003c/strong\u003e \u003cp\u003eSize, location, and number of stones (though stone composition data was not consistently available and thus not included in the primary analysis).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOutcome variables\u003c/strong\u003e \u003cp\u003eDetailed records of stone clearance (assessed by follow-up imaging, typically KUB or CT scan, performed within 1\u0026ndash;3 months post-op), incidence and duration of postoperative fever, diagnosis of sepsis, requirement for blood transfusion, and total duration of hospital stay.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eAssessment of Outcomes\u003c/h3\u003e\n\u003cp\u003eEach outcome variable was defined and assessed with specific criteria to ensure consistency and objectivity:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLaboratory (Hemoglobin Drop)\u003c/strong\u003e \u003cp\u003eThe mean hemoglobin drop was calculated as the difference between the highest pre-operative hemoglobin level and the lowest post-operative hemoglobin level recorded within the first 48 hours following PCNL. Values were expressed in grams per deciliter (g/dL).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFever\u003c/strong\u003e \u003cp\u003ePostoperative fever was defined as an oral temperature greater than or equal to 38.0\u0026deg;C (100.4\u0026deg;F) recorded on at least two separate occasions, or a single temperature greater than or equal to 38.5\u0026deg;C (101.3\u0026deg;F), monitored every 6 hours during the hospital stay.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSepsis\u003c/strong\u003e \u003cp\u003eThe diagnosis of sepsis was retrospectively evaluated based on clinical records, physician notes, microbiology results (e.g., positive blood cultures), initiation of broad-spectrum antibiotics for suspected infection, and documented fulfillment of the Sepsis-3 criteria (e.g., an acute change in SOFA score of 2 points or greater) \\cite{ref5}.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStone Clearance\u003c/strong\u003e \u003cp\u003eStone clearance was determined through post-operative imaging (plain abdominal radiograph (KUB) and/or non-contrast computed tomography (CT) scan) performed approximately 1\u0026ndash;3 months after the procedure. Complete stone clearance was defined as no residual fragments detectable, or clinically insignificant residual fragments (CIRF) less than 2\u0026ndash;4 mm, without evidence of obstruction or infection \\cite{ref6}.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBlood Transfusion\u003c/strong\u003e \u003cp\u003eThe requirement for blood transfusion was ascertained by reviewing intraoperative and postoperative medical orders, nursing records, and blood bank transfusion logs.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHospital Stay\u003c/strong\u003e \u003cp\u003eThe total duration of hospital stay was precisely calculated from the date of admission for PCNL to the date of discharge, expressed in days.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll collected data were meticulously entered into and analyzed using SPSS statistical software, version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were employed to summarize the baseline characteristics of both groups, including means and standard deviations (SD) for continuous variables, and frequencies and percentages for categorical variables. Inferential statistical analyses were then performed to compare the two groups:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eContinuous variables\u003c/strong\u003e \u003cp\u003eIndependent samples t-tests were utilized to compare means (e.g., age, hemoglobin drop, hospital stay) between the hydronephrotic and non-hydronephrotic groups.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCategorical variables\u003c/strong\u003e \u003cp\u003eChi-square (\u003cspan\u003e$\u003c/span\u003e\\chi^2\u003cspan\u003e$\u003c/span\u003e) tests were applied to assess significant differences in proportions (e.g., rates of fever, sepsis, blood transfusion, stone clearance) between the two groups. Fisher's exact test was used when expected cell counts were less than 5.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRisk assessment\u003c/strong\u003e \u003cp\u003eRelative Risks (RR) and Odds Ratios (OR) were calculated for key binary outcomes (e.g., complications like fever, sepsis, or presence of kidney disease) along with their respective 95% Confidence Intervals (CI) to quantify the strength and direction of associations.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA p-value of less than 0.05 was considered statistically significant for all comparisons.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eThe study protocol, including all methods and procedures involving human participants, was rigorously reviewed and received full approval from the Ethics Committee of Ardabil University of Medical Sciences (Ethics Code: 1403.073REC.MEDICINE.ARUMS.IR). All procedures were conducted in strict adherence to the ethical standards laid down in the 1964 Helsinki Declaration and its subsequent amendments. Informed consent was obtained from all patients prior to their inclusion in the study, clearly outlining the study's purpose, procedures, potential risks, and benefits. To ensure the privacy and confidentiality of patient data, all collected information was anonymized and de-identified prior to analysis, and personal identifiers were meticulously protected throughout the entire study duration.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study meticulously analyzed data from 170 patients who underwent PCNL, equally divided into 85 patients in the hydronephrotic group and 85 patients in the non-hydronephrotic group.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the baseline demographic and clinical characteristics were largely comparable between the two cohorts, indicating a good match and minimizing confounding factors. The mean age was 47.95\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years in the hydronephrotic group and 48.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12 years in the non-hydronephrotic group, with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.28). Similarly, gender distribution showed male predominance in both groups (61.6% in hydronephrotic vs. 58.8% in non-hydronephrotic, p\u0026thinsp;=\u0026thinsp;0.725), reflecting typical urolithiasis epidemiology. Marital status also demonstrated high rates of married individuals in both groups (91.9% vs. 97.5%, p\u0026thinsp;=\u0026thinsp;0.129), again without significant difference.\u003c/p\u003e \u003cp\u003eRegarding comorbidities, the prevalence of kidney disease was numerically higher in the hydronephrotic group (17.6%) compared to the non-hydronephrotic group (8.2%), although this difference did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.221). Liver disease was rare, present in 4.7% of the non-hydronephrotic group and absent in the hydronephrotic group (p\u0026thinsp;=\u0026thinsp;0.236). Importantly, rates of pre-existing sepsis (9.4% vs. 12.0%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and fever (36.5% vs. 31.8%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) before or immediately post-procedure were not statistically different between the groups. Mean hospital stay duration was also similar (4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 days for hydronephrotic vs. 3.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 days for non-hydronephrotic, p\u0026thinsp;=\u0026thinsp;0.765), as were the mean number of follow-up visits (2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 vs. 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2, p\u0026thinsp;=\u0026thinsp;0.25).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Baseline Characteristics between Hydronephrotic and Non-Hydronephrotic Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHydronephrotic Group (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Hydronephrotic Group (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.95\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (61.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (58.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (91.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (97.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stay, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up visits, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHydronephrotic Group (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Hydronephrotic Group (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.95\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (61.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (58.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (91.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (97.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stay, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up visits, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComplications\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHydronephrotic Group (% cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Hydronephrotic Group (% cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConfidence Interval (95%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.5% (31/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.8% (27/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[0.65\u0026ndash;2.23]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.4% (8/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.0% (10/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[0.30\u0026ndash;1.96]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.6% (15/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.2% (7/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[0.87\u0026ndash;6.58]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0% (0/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7% (4/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSepsis\u003c/strong\u003e \u003cp\u003eThe rate of postoperative sepsis was 9.4% in the hydronephrotic group and 12.0% in the non-hydronephrotic group. This difference was not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that calyceal status did not predispose patients to a higher risk of systemic infection.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFever\u003c/strong\u003e \u003cp\u003ePostoperative fever occurred in 36.5% of hydronephrotic patients and 31.8% of non-hydronephrotic patients. Again, this difference was not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), suggesting similar inflammatory responses or infection rates regardless of calyceal dilatation.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRelative Risk (RR) and Odds Ratios (OR) for Complications\u003c/h2\u003e \u003cp\u003eTo further quantify the association between calyceal status and various outcomes, Relative Risks (RR) and Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated. These are presented in the following table:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between Hydronephrotic Status and Key Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHydronephrotic Group (% cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Hydronephrotic Group (% cases)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConfidence Interval (95%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.5% (31/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.8% (27/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[0.65\u0026ndash;2.23]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.4% (8/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.0% (10/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[0.30\u0026ndash;1.96]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.6% (15/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.2% (7/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[0.87\u0026ndash;6.58]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0% (0/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7% (4/85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe calculated RR for fever was 1.14 (meaning hydronephrotic patients were 1.14 times as likely to develop fever), with an OR of 1.21 (95% CI: 0.65\u0026ndash;2.23). For sepsis, the RR was 0.78 and the OR was 0.76 (95% CI: 0.30\u0026ndash;1.96), indicating a slightly \u003cem\u003elower\u003c/em\u003e (though not statistically significant) risk in the hydronephrotic group. For kidney disease, the RR was 2.14 and the OR was 2.40 (95% CI: 0.87\u0026ndash;6.58), suggesting that hydronephrotic patients were more than twice as likely to have pre-existing kidney disease, though the wide confidence interval overlapping unity indicates that this difference did not reach statistical significance at the 0.05 level. The N/A for liver disease indicates that no cases were observed in one of the groups, preventing calculation of OR/RR.\u003c/p\u003e \u003cp\u003eOverall, these findings strongly suggest that while anatomical differences exist in calyceal morphology, they do not translate into significant differences in the rates of major postoperative complications such as fever or sepsis, or in the duration of hospital stay following PCNL. The implication of pre-existing kidney disease in the hydronephrotic group, although not statistically significant in this sample, warrants further investigation in larger cohorts.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this cross-sectional study provide valuable insights into the comparative postoperative outcomes and complications of PCNL in patients with hydronephrotic versus non-hydronephrotic calyces. Our comprehensive analysis demonstrated that most clinical and laboratory results were remarkably comparable between the two groups. Specifically, we observed no statistically significant differences in the rates of postoperative fever, incidence of sepsis, duration of hospital stay, or the effectiveness of stone clearance. This suggests that the anatomical status of the calyces, whether dilated or normal, does not significantly impact these critical success and safety parameters of PCNL.\u003c/p\u003e \u003cp\u003eA notable observation, though not reaching statistical significance, was the numerically higher prevalence of underlying kidney disease within the hydronephrotic group (17.6%) compared to the non-hydronephrotic group (8.2%). This finding, consistent with the pathophysiological understanding of hydronephrosis often being a consequence of chronic obstruction leading to renal damage, underscores the importance of a thorough baseline renal function assessment in these patients. While PCNL may resolve the acute obstruction, pre-existing renal compromise may necessitate more vigilant long-term follow-up and management for these individuals \\cite{ref7}.\u003c/p\u003e \u003cp\u003eThe absence of a significant difference in mean hemoglobin drop between the two groups is also noteworthy. Intuitively, one might hypothesize that hydronephrotic calyces, often characterized by thinner and potentially more fragile walls, could be associated with a higher risk of bleeding during tract creation and dilation. However, our data do not support this hypothesis. This could be attributed to several factors: modern PCNL techniques, including smaller tract sizes (e.g., mini-PCNL), precise needle guidance (e.g., fluoroscopic or ultrasound guidance), and careful tract dilation methods, have significantly mitigated the risk of parenchymal injury and subsequent hemorrhage \\cite{ref8}. Furthermore, the meticulous hemostatic measures employed during the procedure, irrespective of calyceal status, contribute to minimizing blood loss.\u003c/p\u003e \u003cp\u003eOur results align with a growing body of literature that emphasizes the increasing importance of surgeon expertise, meticulous technique, and comprehensive patient comorbidities over anatomical factors alone in determining PCNL outcomes \\cite{ref9}. While hydronephrotic calyces may indeed offer a larger target for initial percutaneous access, potentially simplifying the initial puncture, their fragile walls do not appear to translate into a higher complication rate in skilled hands. Conversely, non-hydronephrotic calyces, while possibly more challenging to access due to their normal size, do not inherently lead to worse outcomes, suggesting that experienced surgeons can navigate these anatomical nuances effectively.\u003c/p\u003e \u003cp\u003eThe similar rates of postoperative fever and sepsis across both groups highlight the critical role of stringent infection control protocols and appropriate prophylactic antibiotic regimens in PCNL. Regardless of calyceal dilatation, the risk of urinary tract infection and subsequent systemic inflammatory response remains a concern. Our findings suggest that current standards of perioperative infection management are equally effective in both patient populations.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eThis study is not without limitations. Firstly, its single-center design may limit the generalizability of the findings to other institutions with different patient populations, surgical volumes, or surgical expertise. Secondly, despite a robust sample size calculation, the relatively small sample size, especially for less frequent complications, might have limited the statistical power to detect smaller, yet clinically relevant, differences between the groups, particularly regarding kidney disease prevalence. Thirdly, the study lacked detailed data on stone composition, which is known to influence stone fragility and removal difficulty \\cite{ref10}. Fourthly, the retrospective nature of data collection inherently introduces potential for information bias, although rigorous data extraction protocols were followed. Finally, the absence of long-term follow-up beyond immediate postoperative period means we could not assess long-term renal function changes, stone recurrence rates, or delayed complications that might manifest differently between the groups. Future multicenter, prospective studies with larger cohorts and extended follow-up periods are warranted to further elucidate these aspects.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study demonstrates that the calyceal condition, specifically whether it is hydronephrotic or non-hydronephrotic, does not significantly influence the primary postoperative outcomes or major complication rates following percutaneous nephrolithotomy. This reinforces the safety and adaptability of PCNL across varying anatomical presentations when performed by experienced surgeons employing contemporary techniques. However, it is important to recognize that pre-existing kidney disease appears to be more prevalent in patients presenting with hydronephrosis, even if not statistically significant in this cohort. This underscores the necessity for individualized patient management, thorough preoperative assessment of renal function, and continued vigilance during follow-up for these patients. The findings collectively emphasize that advanced surgical practices, combined with meticulous perioperative care and stringent sterile techniques, are paramount for optimizing patient outcomes in PCNL, irrespective of the underlying calyceal anatomy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCNL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePercutaneous Nephrolithotomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRelative Risk\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKUB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKidney, Ureter, Bladder (plain abdominal radiograph)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCIRF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinically Insignificant Residual Fragments\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSequential Organ Failure Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003cbr\u003e\u003c/strong\u003eThe study protocol was thoroughly reviewed and received full ethical approval from the Ethics Committee of Ardabil University of Medical Sciences, under the ethics code 1403.073REC.MEDICINE.ARUMS.IR. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Prior to their inclusion in the study, all patients provided their informed consent to participate. This consent process included a detailed explanation of the study's objectives, procedures, potential risks, and benefits, ensuring their voluntary participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003cbr\u003e\u003c/strong\u003eInformed consent for the publication of anonymized data and research findings derived from their participation was obtained from all participants. This ensures that the study's results can be disseminated in scientific literature while upholding patient confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003cbr\u003e\u003c/strong\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Data will be provided in an anonymized format to protect patient privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003cbr\u003e\u003c/strong\u003eThe authors declare that they have no competing interests, including financial, personal, or other relationships that could be perceived to influence the work reported in this paper. All authors maintain full independence from any organization or entity with a financial interest in the subject matter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003cbr\u003e\u003c/strong\u003eNo external funding was received for this study. The research was conducted using institutional resources and the voluntary contributions of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003cbr\u003e\u003c/strong\u003eAll authors made significant contributions to the conception and design of the study. Hamed Mohseni Rad, MD, played a primary role in the study design, methodology, and manuscript drafting, serving as the corresponding author. Farzin Valizadeh, MD, contributed significantly to patient selection, data acquisition, and critical revision of the manuscript. Ali Hoseinkhani assisted with the statistical analysis, interpretation of results, and contributed to the discussion section. Mohammadreza Ebrahimi Saghezchi was instrumental in data extraction, organization, and preliminary data analysis. All authors actively participated in the intellectual content, critically reviewed and revised successive drafts of the manuscript, and ultimately approved the final version for submission. They collectively take responsibility for the integrity and accuracy of the data and analysis presented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003cbr\u003e\u003c/strong\u003eThe authors extend their sincere gratitude and appreciation to the dedicated clinical staff, nurses, and administrative personnel of Imam Reza Medical Center for their invaluable support and assistance in facilitating patient care and data collection, which were crucial for the successful completion of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eScales JA, Smith E, Hanley N. Urolithiasis: a contemporary review. \u003cem\u003eNat Rev Urol\u003c/em\u003e. 2012;9(11):625-634.\u003c/li\u003e\n\u003cli\u003ePortis AJ, Clayman RV. Percutaneous nephrolithotomy: clinical efficacy and morbidity. \u003cem\u003eUrol Clin North Am\u003c/em\u003e. 2115;27(1):161-172.\u003c/li\u003e\n\u003cli\u003eT\u0026uuml;rk C, Knoll T, Petrik A, et al. EAU Guidelines on Urolithiasis 2020. European Association of Urology. Available at: www.uroweb.org/guidelines/urolithiasis/\u003c/li\u003e\n\u003cli\u003eGanpule A, Singh B, Sharma R, et al. Factors affecting outcomes of percutaneous nephrolithotomy for staghorn calculi: a prospective study. \u003cem\u003eUrol Int\u003c/em\u003e. 2013;90(1):86-91.\u003c/li\u003e\n\u003cli\u003eSinger M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). \u003cem\u003eJAMA\u003c/em\u003e. 2016;315(8):801-810.\u003c/li\u003e\n\u003cli\u003ePearle MS, Antonelli JA, Gallucci M, et al. Clinically insignificant residual fragments after percutaneous nephrolithotomy: a contemporary review. \u003cem\u003eUrolithiasis\u003c/em\u003e. 2019;47(1):15-22.\u003c/li\u003e\n\u003cli\u003eKhosravi M, Hemmati R, Asadpour A, et al. The correlation between severity of hydronephrosis and renal damage in adult patients with unilateral obstructive uropathy. \u003cem\u003eNephrourol Monthly\u003c/em\u003e. 2014;6(2):e14711.\u003c/li\u003e\n\u003cli\u003eDessoky H, El-Gamal O, Badr A, et al. Outcomes of mini-percutaneous nephrolithotomy (mini-PCNL) versus standard PCNL for renal stones in different sizes. \u003cem\u003eArab J Urol\u003c/em\u003e. 2018;16(2):220-225.\u003c/li\u003e\n\u003cli\u003eAkman T, Binbay M, Sari E, et al. Factors affecting the complication rates of percutaneous nephrolithotomy: analysis of 2974 consecutive cases. \u003cem\u003eJ Endourol\u003c/em\u003e. 2012;26(1):71-77.\u003c/li\u003e\n\u003cli\u003eDiri A, Diri B, Akman T, et al. Stone composition analysis for prediction of percutaneous nephrolithotomy outcome. \u003cem\u003eUrolithiasis\u003c/em\u003e. 2013;41(4):353-357.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Percutaneous nephrolithotomy, hydronephrosis, postoperative complications, kidney stones, urolithiasis, surgical outcomes","lastPublishedDoi":"10.21203/rs.3.rs-6813776/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6813776/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003ePercutaneous nephrolithotomy (PCNL) is the preferred treatment for large or complex renal stones. Calyceal status (hydronephrotic versus non-hydronephrotic) at the time of PCNL access may influence postoperative outcomes and complications. Understanding these potential influences is crucial for surgical planning and patient counseling.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional study was meticulously conducted on patients undergoing PCNL at a single academic medical center. Patients were rigorously divided into two distinct groups: hydronephrotic and non-hydronephrotic, based on objective assessments of their calyceal status at the point of surgical access. Key perioperative and postoperative parameters were systematically collected and analyzed. These parameters included: mean hemoglobin drop (reflecting potential blood loss), total hospitalization duration, stone clearance rates (assessed by postoperative imaging), incidence of sepsis, need for blood transfusion, degree of creatinine elevation (indicating renal function changes), and occurrence of fever. Statistical comparisons between the two groups were performed using appropriate tests such as Chi-square for categorical variables and t-tests for continuous variables, along with the calculation of Relative Risks (RR) and Odds Ratios (OR) with 95% Confidence Intervals (CI) where applicable.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA comprehensive comparative analysis revealed striking similarities in most postoperative outcomes across both groups. Specifically, there was no statistically significant difference observed in the mean hemoglobin drop, average hospital stay, overall stone clearance rates, or the incidence of fever and sepsis between the hydronephrotic and non-hydronephrotic cohorts. However, a notable finding was that the hydronephrotic group exhibited a numerically higher, though not statistically significant, risk of pre-existing underlying kidney disease. This suggests a potential association between hydronephrosis and baseline renal impairment. The overall similarity in outcomes underscores that modern surgical techniques, coupled with diligent perioperative management, have largely minimized the impact of anatomical variations on the majority of postoperative outcomes.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThe study concludes that the calyceal condition, specifically whether it is hydronephrotic or non-hydronephrotic, did not significantly alter the perioperative or major complication rates following PCNL. This implies that with current surgical standards, PCNL can be performed safely and effectively regardless of the initial calyceal dilatation. Nevertheless, it is important to acknowledge that patients presenting with hydronephrosis may be inherently more susceptible to chronic kidney disease, necessitating tailored and vigilant perioperative care. The findings also reinforce the critical role of advanced surgical techniques and stringent sterile practices in optimizing patient outcomes and mitigating potential risks associated with varying anatomical presentations.\u003c/p\u003e","manuscriptTitle":"Postoperative Outcomes and Complications of PCNL: A Comparative Study of Hydronephrotic and Non-Hydronephrotic Calyces","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 11:37:20","doi":"10.21203/rs.3.rs-6813776/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f40eaf43-7ce4-4bd4-b0ea-8d160c483a58","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-11T20:23:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 11:37:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6813776","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6813776","identity":"rs-6813776","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}