Comparison of Preoperative and Intraoperative Cultures for Predicting Postoperative Urinary Tract Infections Following Supine PCNL

Comparison of Preoperative and Intraoperative Cultures for Predicting Postoperative Urinary Tract Infections Following Supine PCNL | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Preoperative and Intraoperative Cultures for Predicting Postoperative Urinary Tract Infections Following Supine PCNL Gunal Ozgur, Dogancan Dorucu, Orhan Buğra Duran, Ersin Gokmen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7722932/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Mar, 2026 Read the published version in World Journal of Urology → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction: This study aimed to compare the predictive value of preoperative midstream urine culture (PMUC), intraoperative renal pelvic urine culture (RPUC), and stone culture (SC) for postoperative urinary tract infections (UTIs) following percutaneous nephrolithotomy (PCNL). Methods: We retrospectively analyzed 234 patients who underwent supine-PCNL between January 2020 and April 2025. UTI was diagnosed based on systemic inflammatory response syndrome criteria and elevated inflammatory markers. Demographic, peri-, intra- and post-operative data were compared between patients with and without UTI. Multivariate logistic regression identified independent predictors. Results: UTI occurred in 14.1%(n=33) of patients postoperatively, with 72.7% presenting with fever. Culture positivity rates were significantly higher in postoperative UTI-patients (PMUC=27.3%vs.7.5%, SC:39.4%vs.8.0% and RPUC:30.3%vs.6.0%; p<0.001). In UTI-patients, only 15.2% of postoperative urine cultures obtained before antibiotic treatment showed bacterial growth, which was lower than intraoperative cultures. UTI was higher in female patients (60.6% vs. 39.4%) and in those with an ASA score of 3 (p=0.001 and p=0.020). Female gender (OR=3.71, p=0.004), ASA-3 score (OR=5.13, p=0.029), positive SC (OR=5.83, p=0.001), and RPUC (OR=3.67, p=0.023) were independent predictors of postoperative UTI. PMUC was not associated (p = 0.65) with postoperative UTI in the multivariate analysis. Conclusions: Intraoperative SC and RPUC are superior to PMUC in predicting UTI after supine PCNL and should be routinely obtained. Female gender and ASA-3 score are independent risk factors. In patients who develop UTI, prior empirical or prophylactic antibiotic use may limit pathogen detection in postoperative urine cultures; therefore, intraoperative cultures play a critical role in early and targeted treatment. Complications Kidney calculi Percutaneous nephrolithotomy Urinary tract infections Urine culture Figures Figure 1 Introduction Percutaneous nephrolithotomy (PCNL) is the first-line option for treatment of large renal stones (>2 cm) [1]. Although PCNL has a very low complication rate, postoperative infections represent a significant concern. Postoperative fever occurs in approximately 10.8% of patients, while sepsis is reported in about 0.5% [2]. Antibiotic prophylaxis combined with a sterile preoperative midstream urine culture (PMUC) has been shown to reduce the risk of postoperative fever and related complications [3]. Nevertheless, infectious complications may still occur in the postoperative period despite these precautions, and devastating outcomes due to urosepsis may be experienced [4, 5]. Bacterial colonization within kidney stones and increased intrapelvic pressure during surgery are thought to contribute to the development of postoperative infectious complications [1, 6]. Given that kidney stones may serve as a source of infection, intraoperative renal pelvic urine culture (RPUC) and stone culture (SC) have been reported to be more reliable than PMUC in identifying the causative microorganisms [7]. These intraoperative cultures are considered particularly important for the early and effective management of post-operative infectious events. The European Association of Urology (EAU) guidelines also emphasize that SC or urine culture obtained directly from the renal pelvis provide greater predictive value for postoperative sepsis compared to PMUC [1]. Several studies have examined the associations between PMUC, intraoperative RPUC and SC with infectious outcomes following PCNL [8]. However, studies comparing all three culture types within the same patient cohort are limited. Moreover, some discrepancies exist among the results of these studies [9]. The primary aim of this study is to evaluate the relationship between these three types of cultures and the development of urinary tract infections (UTIs) following PCNL. The secondary aim is to identify the clinical characteristics of patients who develop postoperative UTIs. Materials and Methods This study was approved by the Institutional Review Board (Approval No: 09.2025.25-0192) and conducted in accordance with the principles of the Declaration of Helsinki. A retrospective analysis was performed on patients who underwent supine PCNL for kidney stones between January 2020 and April 2025. Patients were included if they had available PMUC and intraoperative RPUC and SC. Exclusion criteria included simultaneous bilateral endoscopic surgery (SBES), anatomical or functional urinary tract anomalies (e.g., ureteropelvic junction obstruction, horseshoe kidney, vesicoureteral reflux), diagnosis of immunodeficiency, or age under 18 years. In accordance with the recommendations of the EAU guidelines, a PMUC was obtained from all patients included in the study [1]. For those with sterile cultures, antibiotic prophylaxis was determined in collaboration with the institution’s infectious diseases committee, taking into account local antimicrobial susceptibility patterns [10]. Patients with sterile urine cultures received a single dose of 2 g ceftriaxone administered within 30 minutes prior to the surgical incision. In patients with positive urine cultures, antibiotic treatment was initiated based on antimicrobial susceptibility testing and continued for a minimum of seven days, as recommended by the infectious diseases specialists. Once sterile cultures were achieved, these patients underwent surgery with the appropriate prophylactic antibiotic regimen as guided by infectious diseases consultation. In statistical analysis, these patients were classified as PMUC positive. All PCNL procedures were performed in the supine Galdakao-Modified Valdivia position by experienced endourologists. During the operation, urine sample was obtained directly from the renal pelvis for RPUC. Following stone fragmentation, stone fragments were collected for SC. In the postoperative period, patients who developed systemic inflammatory response syndrome (SIRS; defined as having two or more of the following: temperature 38 °C, heart rate >90 bpm, respiratory rate >20 breaths per minute, or white blood cell count 12000/mm³) and showed elevations in acute phase reactants (C-reactive protein, procalcitonin), were evaluated by the Infectious Diseases Department. Patients diagnosed with infection received appropriate antibiotic regimen and these patients were classified as positive for UTI. Patients were divided into two groups based on the presence or absence of post-operative UTI. Within the scope of the study, demographic data, stone characteristics, pre- and peri-operative surgical parameters, and postoperative clinical outcomes were evaluated. In addition, the results of PMUC, as well as intraoperative SC and RPUC, were analyzed. All parameters were compared between patients with and without post-operative UTI to determine potential associations. Statistical Analysis All analyses were performed using IBM SPSS Statistics version 25. Normality of variables was assessed via visual (histograms, probability plots) and analytical methods (Kolmogorov–Smirnov/Shapiro–Wilk tests). Descriptive statistics were expressed as mean (±standard deviation:SD) for normally distributed variables and median (interquartile range:IQR) for non-normally distributed ones. Group comparisons were made using the independent t-test or Mann–Whitney U test, depending on distribution. Categorical variables were compared using Chi-square or Fisher’s exact test where appropriate. Multivariate logistic regression was performed to identify independent predictors of postoperative UTI, including factors with p<0.25 in univariate analysis. A p-value <0.05 was considered statistically significant. Results A total of 234 patients were included in the study. The incidence of postoperative UTI was 14.1% (n=33). Postoperative early fever was detected in 29 patients (12.4%). While only 3% of patients without postoperative UTI had fever, the incidence was markedly higher at 72.7% in the UTI-positive group. Five patients (2.14%) required intensive care unit monitoring due to urosepsis. One elderly patient (0.4%) with cardiac and neurological comorbidities developed a renal hematoma and sepsis after surgery and died while being monitored in the intensive care unit. There were no significant differences between UTI-positive and UTI-negative patients in terms of age, BMI, presence of diabetes, stone size, or laterality of surgery (p>0.05). However, the proportion of female patients was significantly higher in the UTI-positive group (60.6% vs. 39.4%; p=0.001). In addition, the occurrence of UTI was more common among patients with an ASA score of 3 (p=0.020) (Table 1). The groups were comparable with respect to Amplatz sheath size, use of flexible ureteroscopy (ECIRS), urinary drainage method, Foley catheter use, operation time (OT), and stone-free rates (p>0.05). However, the length of hospital stay was significantly longer in the UTI-positive group (8 [7–10] vs. 2 [2–3] days; p<0.001) (Table 2). In the UTI-positive group, the rates of positive PMUC (27.3% vs 7.5%; p=0.002), SC (39.4% vs %8; p<0.001), and RPUC (30.3% vs 6%; p<0.001) were all significantly higher compared to the UTI-negative group (Figure 1). Notably, in UTI patients receiving antibiotics upon infectious disease consultation, post-operative urine cultures taken before treatment showed growth in only 15.2% of cases. Multivariate logistic regression analysis showed that female gender (OR = 3.71, 95% CI: 1.52–9.06, p = 0.004), ASA-3 score (vs ASA-1; OR = 5.13, 95% CI: 1.19–22.18, p = 0.029), positive intra-operative SC (OR = 5.83, 95% CI: 1.99–17.03, p = 0.001), and RPUC (OR = 3.67, 95% CI: 1.20–11.27, p = 0.023) were identified as independent predictors of post-operative UTI (Table 3). Discussion PCNL remains the first-line treatment for staghorn and large renal calculi [1]. Despite its minimally invasive nature, it is associated with complications such as bleeding, infection, sepsis, and injury to adjacent organs [11]. Among these, sepsis stands out as a major cause of morbidity and mortality in stone disease [12]. Infectious complications can still occur in patients with sterile PMUC under antibiotic prophylaxis in PCNL [7]. Bacterial colonization within large kidney stones is believed to increase the risk of infection after surgery [7, 13]. Therefore, several studies have investigated whether RPUC and SC are more effective than PMUC in predicting postoperative SIRS or sepsis. Li et al. reported the incidence of SIRS and urosepsis following PCNL to be approximately 21% and 6%, respectively. They also found SC positivity (21%) to be higher than PMUC (16%) and RPUC (10%) positivity [9]. Mariappan et al. reported SC positivity in 35.2% of cases, RPUC in 20.4%, and PMUC in 11.1% [4]. In our study, the incidence of UTI was 14.1%, and SC showed the highest culture positivity rate among UTI-positive patients (SC:39.4%, RPUC:30.3%, PMUC:27.3%). Notably, SC and RPUC growth was also detected in some patients without postoperative UTI (SC:8%, RPUC:6%). The predictive value of different culture types in postoperative UTI has been previously evaluated. Li et al. found SC positivity to be more strongly associated with SIRS than PMUC or RPUC [9]. Patients with positive SC had a fivefold higher risk of postoperative infection (OR:5.03, p=0.002) [14]. SC and RPUC have stronger predictive power for postoperative SIRS or sepsis compared to PMUC [7]. Patients with infected SC or RPUC have been found to have a fourfold higher risk of urosepsis (p=0.009) [4]. In a meta-analysis by Zhou et al., positive PMUC (OR=3.16 95%CI 2.11-4.74), RPUC (OR=5.81, 95%CI 1.75–19.32), and SC (OR=5.11, 95%CI: 1.46–17.89) were all identified as predictors of post-PCNL infectious complications [8]. Consistent with these findings, our multivariate analysis showed that intraoperative SC (OR=5.83, p=0.001) and RPUC (OR=3.67, p=0.023) as independent predictors of postoperative UTI and demonstrated a higher predictive value for infection complications after PCNL compared to PMUC (OR=1.32, p=0.65) [4, 7]. The lack of statistical significance for PMUC may be attributed to the administration of appropriate pre-operative antibiotic therapy in patients with positive results. Interestingly, among patients diagnosed with post-operative UTI following infectious disease consultation, only 15.2% had positive growth in urine cultures obtained before the initiation of antibiotic treatments. The low culture positivity rate may be related to previous empirical/ prophylaxis antibiotic use or low bacterial load at the time of sampling. Given the limited utility of post-operative urine cultures in identifying causative pathogens, intra-operative SC and RPUC cultures are more valuable for guiding early and effective treatment. Early intervention is critical in patients with sepsis to reduce morbidity and mortality [15]. Initiation of appropriate antibiotic is essential in patients with UTI. Given the delay in obtaining culture results, intraoperative SC and RPUC may facilitate early targeted treatment and improve outcomes in patients with sepsis [16]. Therefore, it is recommended to routinely obtain SC and RPUC during PCNL procedures whenever possible [7]. Culture positivity is an independent risk factor for infectious complications after PCNL. Thus, ensuring sterile urine before surgery and administering appropriate antibiotics in cases where sterility cannot be achieved is crucial [1]. However, various patient-related, stone-related or surgical parameters were also evaluated for infective complications after PCNL and conflicting results are observed in the literature. The role of gender in post-PCNL infections remains controversial. While some studies report no significant association between gender and infection risk [9, 17, 18], Değirmenci et al. observed a higher SIRS rate in male patients [19]. However, female patients are more likely to have positive urine cultures than males (42.9% vs. 21.5%, p<0.01) [20]. Zhu et al. reported a possible association between female sex and increased rates of urosepsis [5]. Similarly, Zhou et al. reported that female gender increased the risk of infectious complications by more than 1.5 times (OR = 1.60, 95% CI 1.23–2.07) [8]. Our study also showed that the proportion of female patients was significantly higher in the postoperative UTI group (60.6% vs. 28.4%, p=0.001), and multivariate analysis confirmed that female gender is an independent predictor of postoperative UTI (OR=3.71, p=0.004). Stone burden may be associated with an increased risk of urosepsis. While Rivera et al. found no significant correlation between stone size and postoperative infections, they reported a higher incidence of UTI in patients with multiple stones [17]. In our study, patients in the postoperative UTI group had a higher median stone number (3 [IQR 1–4] vs. 2 [IQR 1–3], p=0.024); however, stone size did not differ significantly between the groups, and multivariate analysis did not identify stone number as an independent risk factor for postoperative UTI. The association between OT and infection is also debated. Some studies report no significant relationship [9, 17], while others have identified OT as an independent risk factor [5, 8, 21]. In our study, the median OT was slightly longer in the UTI group (130 [IQR 102–180] vs 120 [IQR 90–150] minutes); however, this difference was not statistically significant (p=0.172), and OT was not identified as an independent predictor in the multivariate analysis. In line with earlier studies, our findings revealed no significant association between age, BMI, or diabetes and the development of postoperative urinary tract infection [9, 17, 21]. Increased intrarenal pressure during PCNL may lead to systemic bacterial translocation through tubular, lymphatic, and venous backflow [13]. Smaller tract sizes may be associated with higher intrapelvic pressures and increased risk of postoperative infection [6]. However, we found no significant association between Amplatz sheath size and infectious complications. A randomized prospective study by Sener et al. found no difference in infection parameters between patients with and without a postoperative foley catheter following ureterorenoscopy [22]. However, to our knowledge, there are no high-level evidence studies evaluating the impact of postoperative foley catheter use on infections after PCNL. In our study, postoperative Foley catheter placement was more common in the group with UTI (33.5% vs. 21.9%), but this difference was not statistically significant (p = 0.151) and was not identified as an independent predictor in multivariate analysis. Study Limitations This study has several limitations. First, its retrospective design may have introduced selection and information bias. Second, the analysis was conducted at a single tertiary referral center, which may limit the generalizability of the findings to other institutions or populations with different microbiological flora or surgical protocols. Third, although we used multivariate logistic regression to adjust for confounding factors, unmeasured variables such as stone composition, antibiotic resistance profiles, or intraoperative irrigation pressures may have influenced the outcomes. Conclusions Intraoperative stone and renal pelvic urine culture demonstrated superior predictive value for postoperative urinary tract infection after supine percutaneous nephrolithotomy compared with preoperative midstream urine culture. Female sex and higher ASA scores were identified as independent risk factors for postoperative infection. In UTI-positive patients, pathogen identification was also more limited in postoperative urine cultures obtained before antibiotic therapy, particularly when compared with intraoperative cultures. Routine use of intraoperative cultures may facilitate earlier identification of causative organisms and enable rapid initiation of targeted antibiotic therapy, thus potentially reducing the risk of infectious complications and improving patient outcomes. These findings support routine use of intraoperative cultures in all supine PCNL patients. Declarations Funding: No funding was received for conducting this study. Conflict of Interest: No conflict declared. Approval of the research protocol by an Institutional Reviewer Board (IRB): The study protocol was reviewed and approved by the Institutional Review Board (IRB) of Marmara University, School of Medicine (Approval No: 09.2025.25-0192). Informed Consent: This study was conducted retrospectively using previously collected and anonymized data from the PCNL Database; therefore, obtaining written informed consent from participants was not required. Registry and the Registration No. of the study/trial: N/A. This is a retrospective study and registration is not required. Data, Material and/or Code Availability: The datasets, materials, and/or code generated and/or analyzed during the current study are not publicly available. However, they may be made available from the corresponding author on reasonable scientific request due to valid academic or ethical considerations. The use of artificial intelligence: Artificial intelligence (AI) tools were utilized solely for the purpose of language translation. All analysis, and manuscript writing were performed by the authors without AI assistance. Author Contributions: Research conception and design: GO, HKC Data acquisition: OBD, DD, EG, YS Statistical analysis: GO Data analysis and interpretation: GO, TES Drafting of the manuscript: GO Critical revision of the manuscript: HKC, TES Administrative, technical, or material support: GO Supervision: HKC, TES Approval of the final manuscript: all authors. References Skolarikos A (Chair), Neisius HJ,A, Petřík A, Kamphuis GM, Davis NF, Somani B, Tailly T, Lardas M, Gambaro G (Consultant nephrologist) JA Sayer (Consultant nephrologist) Guidelines Associates: R. Geraghty R, Lombardo L Tzelves Guidelines Office: C. Bezuidenhout. (2025) [cited 2025 Seitz C et al (2012) Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 61(1):146–158 Gravas S et al (2012) Postoperative infection rates in low risk patients undergoing percutaneous nephrolithotomy with and without antibiotic prophylaxis: a matched case control study. J Urol 188(3):843–847 Mariappan P et al (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173(5):1610–1614 Zhu Z et al (2020) The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy. World J Urol 38(10):2629–2636 Wu C et al (2017) Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy. Kaohsiung J Med Sci 33(1):36–43 Liu M et al (2021) Preoperative Midstream Urine Cultures vs Renal Pelvic Urine Culture or Stone Culture in Predicting Systemic Inflammatory Response Syndrome and Urosepsis After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. J Endourol 35(10):1467–1478 Zhou G et al (2022) The influencing factors of infectious complications after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 51(1):17 Li Y, Xie L, Liu C (2024) Prediction of systemic inflammatory response syndrome and urosepsis after percutaneous nephrolithotomy by urine culture, stone culture, and renal pelvis urine culture: Systematic review and meta-analysis. Heliyon 10(13):e33155 Schnabel MJ, Wagenlehner FME, Schneidewind L (2019) Perioperative antibiotic prophylaxis for stone therapy. Curr Opin Urol 29(2):89–95 Taylor E et al (2012) Complications associated with percutaneous nephrolithotomy. Transl Androl Urol 1(4):223–228 Whitehurst L, Jones P, Somani BK (2019) Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review. World J Urol 37(5):759–776 Kreydin EI, Eisner BH (2013) Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10(10):598–605 Zheng J et al (2025) Is it necessary for patients with a positive urine culture to achieve a negative result after antimicrobial treatment before undergoing percutaneous nephrolithotomy? World J Urol 43(1):131 Lu Y et al (2018) Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. J Intensive Care Med 33(5):296–309 Singh I et al (2019) Efficacy of Intraoperative Renal Stone Culture in Predicting Postpercutaneous Nephrolithotomy Urosepsis/Systemic Inflammatory Response Syndrome: A Prospective Analytical Study with Review of Literature. J Endourol 33(2):84–92 Rivera M et al (2016) Pre- and Postoperative Predictors of Infection-Related Complications in Patients Undergoing Percutaneous Nephrolithotomy. J Endourol 30(9):982–986 Korets R et al (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186(5):1899–1903 Degirmenci T et al (2019) Does leaving residual fragments after percutaneous nephrolithotomy in patients with positive stone culture and/or renal pelvic urine culture increase the risk of infectious complications? Urolithiasis 47(4):371–375 Liu J et al (2020) Does preoperative urine culture still play a role in predicting post-PCNL SIRS? A retrospective cohort study. Urolithiasis 48(3):251–256 Puia D et al (2023) Can we identify the risk factors for SIRS/sepsis after percutaneous nephrolithotomy? A meta–analysis and literature review. Exp Ther Med 25(3):110 Sener TE et al (2025) Foley catheter after ureteroscopy and JJ stent placement: a randomised prospective European Association of Urology Section of Urolithiasis-Young Academic Urologists (EULIS-YAU) endourology study. BJU Int 135(1):95–102 Tables Table 1. Baseline Demographics and Stone Characteristics by UTI Status Variables UTI (-) N=201 (85.9%) UTI (+) N=33 (14.1%) P value Age, years 46.8 (±16.3) 48.9 (±17.9) 0.498 BMI, kg/m2 27.1 (±5.1) 27.4 (±5) 0.764 Gender, n (%) Male Female 144 (71.6) 57 (28.4) 13 (39.4) 20 (60.6) 0.001 Diabetes mellitus, n (%) No Yes 159 (79.1) 42 (20.9) 28 (84.8) 5 (15.2) 0.445 ASA score, n (%) ASA-1 ASA-2 ASA-3 98 (48.8) 97 (48.3) 6 (3) 13 (39.4) 13 (39.4) 7 (21.2) 0.002 Surgery side, n (%) Right side Left side 110 (54.7) 91 (45.3) 19 (57.6) 14 (42.4) 0.760 Pre-op urinary diversion, n (%) No Double-J stent Nephrostomy 162 (80.6) 30 (14.9) 9 (4.5) 24 (72.7) 4 (12.1) 5 (15.2) 0.079 Number of stones 2 (1-3) 3 (1-4) 0.024 Multiple stones, n (%) No Yes 83 (41.3) 118 (58.7) 9 (27.3) 24 (72.7) 0.126 Largest stone size, mm 25.2 (21.5-31.9) 23 (20-30) 0.325 Continuous variables were compared using the independent samples t-test or Mann–Whitney U test based on distribution. Categorical variables were analyzed using the chi-square test or Fisher’s exact test where appropriate. A p value < 0.05 was considered statistically significant. UTI: urinary tract infection; BMI: body mass index; ASA: American Society of Anesthesiologists; DJ stent: double-J stent; Fr: French; Pre-op: preoperative; Post-op: postoperative. Table 2. Operative and Postoperative Parameters by UTI Status Variables UTI (-) N=201 (85.9%) UTI (+) N=33 (14.1%) P value Amplatz sheath size, n (%) 12/16 Fr 16/20 Fr 20/24 Fr 26/30 Fr 47 (23.4) 111 (55.2) 35 (17.4) 8 (4) 5 (15.2) 21 (63.6) 5 (15.2) 2 (6.1) 0.661 Use of flexible ureteroscopy (ECIRS) No Yes 156 (77.6) 45 (22.4) 29 (87.9) 4 (12.1) 0.179 Post-op urinary drainage, n (%) No Double-J stent Nephrostomy Double-J stent + Nephrostomy 32 (15.9) 127 (63.2) 25 (12.4) 17 (8.5) 5 (15.2) 19 (57.6) 6 (18.2) 3 (9.1) 0.832 Post-op foley catheter placement, n (%) No Yes 157 (78.1) 44 (21.9) 22 (66.7) 11 (33.5) 0.151 Operation time, min 120 (90-150) 130 (102-180) 0.172 Stone-free Status, n (%) Stone-free Single residual fragment Multiple residual fragments 165 (82.1) 21 (10.4) 15 (7.5) 25 (75.8) 4 (12.1) 4 (12.1) 0.698 Fever, n (%) No Yes 195 (97) 6 (3) 9 (27.3) 24 (72.7) 0.000 Pre-op urine culture positivity, n (%) No Yes 186 (92.5) 15 (7.5) 24 (72.7) 9 (27.3) 0.002 Intra-op stone culture positivity, n (%) No Yes 185 (92) 16 (8) 20 (60.6) 13 (39.4) 0.000 Intra-op renal pelvic culture positivity, n(%) No Yes 189 (94) 12 (6) 23 (69.7) 10 (30.3) 0.000 Hospital stay, days 2 (2-3) 8 (7-10) 0.000 Continuous variables were compared using the independent samples t-test or Mann–Whitney U test based on distribution. Categorical variables were analyzed using the chi-square test or Fisher’s exact test where appropriate. A p value <0.05 was considered statistically significant. UTI: urinary tract infection; BMI: body mass index; ASA: American Society of Anesthesiologists; DJ stent: double-J stent; Fr: French; Pre-op: preoperative; Post-op: postoperative. Tablo 3. Independent Predictors of Postoperative UTI OR (Exp(B)) 95% CI p value Gender (female) 3.71 1.52-9.06 0.004 ASA-3 (vs ASA-1) 5.13 1.19-22-18 0.029 Presence of pre-op urinary diversion 0.95 0.339-2.68 0.927 Stone number 1.2 0.94-1.53 0.149 Use of flexible ureteroscopy (ECIRS) 0.53 0.14-1.96 0.338 Operation time 1.002 0.99-1.01 0.548 Post-op foley catheter placement (yes) 2.14 0.79-5.78 0.134 Pre-op urine culture (PMUC) positivity 1.32 0.4-4.41 0.65 Intra-op stone culture (SC) positivity 5.83 1.99-17.03 0.001 Intra-op renal pelvic culture (RPUC) positivity 3.67 1.2-11.27 0.023 Multivariate logistic regression was performed for variables with p<0.25 in univariate analysis. Statistically significant variables are shown as p<0.05. UTI: urinary tract infection; OR: odds ratio; CI: confidence interval; Pre-op: preoperative; Intra-op: intraoperative. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Mar, 2026 Read the published version in World Journal of Urology → Version 1 posted Editorial decision: Revision requested 27 Oct, 2025 Reviews received at journal 25 Oct, 2025 Reviews received at journal 22 Oct, 2025 Reviewers agreed at journal 08 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers invited by journal 05 Oct, 2025 Editor assigned by journal 03 Oct, 2025 Submission checks completed at journal 03 Oct, 2025 First submitted to journal 26 Sep, 2025 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. We do this by developing innovative software and high quality services for the global research community. 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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-7722932","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526299929,"identity":"520c908b-f9c9-4813-abf0-d4d95b568bfc","order_by":0,"name":"Gunal Ozgur","email":"","orcid":"","institution":"Marmara University Pendik Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gunal","middleName":"","lastName":"Ozgur","suffix":""},{"id":526299930,"identity":"241d477f-3f96-46d9-88b7-4460f50d6232","order_by":1,"name":"Dogancan Dorucu","email":"","orcid":"","institution":"Marmara University School of 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Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yusuf","middleName":"","lastName":"Senoglu","suffix":""},{"id":526299934,"identity":"6d613092-ce09-4d93-8ce2-439cea823afc","order_by":5,"name":"Haydar Kamil Cam","email":"","orcid":"","institution":"Marmara University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Haydar","middleName":"Kamil","lastName":"Cam","suffix":""},{"id":526299935,"identity":"0b0badac-f130-4afd-8b9c-a96781c0c048","order_by":6,"name":"Tarik Emre Sener","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYDCCA8icD0DMxk6KFsYZIC3MpGhh5gGTBHTw3T7A+OjmHht7funmY59tfm2T52NmYPzwMQe3FslzCczGOc/SEmfOOZY8O7fvtmEbMwOz5MxtuLUYnGFgk845cDjB4EaOMXNuz21GoBY2Zl78Wth/5xz4b29/I/8zs2XPbXtitLAx5xw4wLhBIoeZmeHH7USCWiTPMDYDHZacOONGmjFjb8Pt5DZmxma8fuE7w3zwc84BO3v+GcmPGX78uW07v7354IePeLQA468Bid2GLkIY/CFF8SgYBaNgFIwUAADPSE7sCiXnqgAAAABJRU5ErkJggg==","orcid":"","institution":"Marmara University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Tarik","middleName":"Emre","lastName":"Sener","suffix":""}],"badges":[],"createdAt":"2025-09-26 14:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7722932/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7722932/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00345-026-06320-5","type":"published","date":"2026-03-02T15:58:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93731058,"identity":"4e84cb7d-9211-4f02-a53d-2e06aac01cd2","added_by":"auto","created_at":"2025-10-17 02:22:55","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":197019,"visible":true,"origin":"","legend":"","description":"","filename":"1.ManuscriptComparisonofPreoperativeandIntraoperativeCulturesforPredictingPostoperativeUrinaryTractInfectionsFollowingSupinePCNL.docx","url":"https://assets-eu.researchsquare.com/files/rs-7722932/v1/bb17533ea97e54db1c8d5afe.docx"},{"id":93731057,"identity":"c556b364-beb6-4341-8103-d445df117d49","added_by":"auto","created_at":"2025-10-17 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02:22:55","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101224,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7722932/v1/ecb33b62a93836939e6466b1.html"},{"id":93731063,"identity":"d8c6e833-9675-4b7e-86c9-e8439f03aad4","added_by":"auto","created_at":"2025-10-17 02:22:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":102459,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of Culture Positivity Rates by Postoperative UTI Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBar chart illustrating the UTI-positive patients showed significantly higher culture positivity rates than UTI-negative patients in all three methods (PMUC: 27.3% vs. 7.5%, SC: 39.4% vs. 8.0%, RPUC: 30.3% vs. 6.0%; p\u0026lt;0.05). Intraoperative cultures, especially SC, showed higher correlation with postoperative UTI.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7722932/v1/176dbd82e1a6322716294d87.png"},{"id":104251174,"identity":"0a2b76ab-3af0-4eee-9ef9-6b66fd0c99c5","added_by":"auto","created_at":"2026-03-09 16:12:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1323664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7722932/v1/87d09a4e-6d5d-49b3-bf2b-0e0ada885189.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Preoperative and Intraoperative Cultures for Predicting Postoperative Urinary Tract Infections Following Supine PCNL","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePercutaneous nephrolithotomy (PCNL) is the first-line option for treatment of large renal stones (\u0026gt;2 cm) [1]. Although PCNL has a very low complication rate, postoperative infections represent a significant concern. Postoperative fever occurs in approximately 10.8% of patients, while sepsis is reported in about 0.5% [2]. Antibiotic prophylaxis combined with a sterile preoperative midstream urine culture (PMUC) has been shown to reduce the risk of postoperative fever and related complications [3]. Nevertheless, infectious complications may still occur in the postoperative period despite these precautions, and devastating outcomes due to urosepsis may be experienced [4, 5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBacterial colonization within kidney stones and increased intrapelvic pressure during surgery are thought to contribute to the development of postoperative infectious complications [1, 6]. Given that kidney stones may serve as a source of infection, intraoperative renal pelvic urine culture (RPUC) and stone culture (SC) have been reported to be more reliable than PMUC in identifying the causative microorganisms [7]. These intraoperative cultures are considered particularly important for the early and effective management of post-operative infectious events. \u0026nbsp;The European Association of Urology (EAU) guidelines also emphasize that SC or urine culture obtained directly from the renal pelvis provide greater predictive value for postoperative sepsis compared to PMUC [1].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral studies have examined the associations between PMUC, intraoperative RPUC and SC with infectious outcomes following PCNL [8]. However, studies comparing all three culture types within the same patient cohort are limited. Moreover, some discrepancies exist among the results of these studies [9]. The primary aim of this study is to evaluate the relationship between these three types of cultures and the development of urinary tract infections (UTIs) following PCNL. The secondary aim is to identify the clinical characteristics of patients who develop postoperative UTIs.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis study was approved by the Institutional Review Board (Approval No: 09.2025.25-0192) and conducted in accordance with the principles of the Declaration of Helsinki. A retrospective analysis was performed on patients who underwent supine PCNL for kidney stones between January 2020 and April 2025. Patients were included if they had available PMUC and intraoperative RPUC and SC. Exclusion criteria included simultaneous bilateral endoscopic surgery (SBES), anatomical or functional urinary tract anomalies (e.g., ureteropelvic junction obstruction, horseshoe kidney, vesicoureteral reflux), diagnosis of immunodeficiency, or age under 18 years.\u003c/p\u003e\n\u003cp\u003eIn accordance with the recommendations of the EAU guidelines, a PMUC was obtained from all patients included in the study [1]. For those with sterile cultures, antibiotic prophylaxis was determined in collaboration with the institution\u0026rsquo;s infectious diseases committee, taking into account local antimicrobial susceptibility patterns [10]. Patients with sterile urine cultures received a single dose of 2 g ceftriaxone administered within 30 minutes prior to the surgical incision. In patients with positive urine cultures, antibiotic treatment was initiated based on antimicrobial susceptibility testing and continued for a minimum of seven days, as recommended by the infectious diseases specialists. Once sterile cultures were achieved, these patients underwent surgery with the appropriate prophylactic antibiotic regimen as guided by infectious diseases consultation. In statistical analysis, these patients were classified as PMUC positive.\u003c/p\u003e\n\u003cp\u003eAll PCNL procedures were performed in the supine Galdakao-Modified Valdivia position by experienced endourologists. During the operation, urine sample was obtained directly from the renal pelvis for RPUC. Following stone fragmentation, stone fragments were collected for SC. In the postoperative period, patients who developed systemic inflammatory response syndrome (SIRS; defined as having two or more of the following: temperature \u0026lt;36 \u0026deg;C or \u0026gt;38 \u0026deg;C, heart rate \u0026gt;90 bpm, respiratory rate \u0026gt;20 breaths per minute, or white blood cell count \u0026lt;4000/mm\u0026sup3; or \u0026gt;12000/mm\u0026sup3;) and showed elevations in acute phase reactants (C-reactive protein, procalcitonin), were evaluated by the Infectious Diseases Department. Patients diagnosed with infection received appropriate antibiotic regimen and these patients were classified as positive for UTI. Patients were divided into two groups based on the presence or absence of post-operative UTI.\u003c/p\u003e\n\u003cp\u003eWithin the scope of the study, demographic data, stone characteristics, pre- and peri-operative surgical parameters, and postoperative clinical outcomes were evaluated. In addition, the results of PMUC, as well as intraoperative SC and RPUC, were analyzed. All parameters were compared between patients with and without post-operative UTI to determine potential associations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll analyses were performed using IBM SPSS Statistics version 25. Normality of variables was assessed via visual (histograms, probability plots) and analytical methods (Kolmogorov\u0026ndash;Smirnov/Shapiro\u0026ndash;Wilk tests). Descriptive statistics were expressed as mean (\u0026plusmn;standard deviation:SD) for normally distributed variables and median (interquartile range:IQR) for non-normally distributed ones. Group comparisons were made using the independent t-test or Mann\u0026ndash;Whitney U test, depending on distribution. Categorical variables were compared using Chi-square or Fisher\u0026rsquo;s exact test where appropriate. Multivariate logistic regression was performed to identify independent predictors of postoperative UTI, including factors with p\u0026lt;0.25 in univariate analysis. A p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 234 patients were included in the study. The incidence of postoperative UTI was 14.1% (n=33). Postoperative early fever was detected in 29 patients (12.4%). While only 3% of patients without postoperative UTI had fever, the incidence was markedly higher at 72.7% in the UTI-positive group. Five patients (2.14%) required intensive care unit monitoring due to urosepsis. One elderly patient (0.4%) with cardiac and neurological comorbidities developed a renal hematoma and sepsis after surgery and died while being monitored in the intensive care unit.\u003c/p\u003e\n\u003cp\u003eThere were no significant differences between UTI-positive and UTI-negative patients in terms of age, BMI, presence of diabetes, stone size, or laterality of surgery (p\u0026gt;0.05). However, the proportion of female patients was significantly higher in the UTI-positive group (60.6% vs. 39.4%; p=0.001). In addition, the occurrence of UTI was more common among patients with an ASA score of 3 (p=0.020) (Table 1).\u003c/p\u003e\n\u003cp\u003eThe groups were comparable with respect to Amplatz sheath size, use of flexible ureteroscopy (ECIRS), urinary drainage method, Foley catheter use, operation time (OT), and stone-free rates (p\u0026gt;0.05). However, the length of hospital stay was significantly longer in the UTI-positive group (8 [7\u0026ndash;10] vs. 2 [2\u0026ndash;3] days; p\u0026lt;0.001) (Table 2). In the UTI-positive group, the rates of positive PMUC (27.3% vs 7.5%; p=0.002), SC (39.4% vs %8; p\u0026lt;0.001), and RPUC (30.3% vs 6%; p\u0026lt;0.001) were all significantly higher compared to the UTI-negative group (Figure 1). Notably, in UTI patients receiving antibiotics upon infectious disease consultation, post-operative urine cultures taken before treatment showed growth in only 15.2% of cases.\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis showed that female gender (OR = 3.71, 95% CI: 1.52\u0026ndash;9.06, p = 0.004), ASA-3 score (vs ASA-1; OR = 5.13, 95% CI: 1.19\u0026ndash;22.18, p = 0.029), positive intra-operative SC (OR = 5.83, 95% CI: 1.99\u0026ndash;17.03, p = 0.001), and RPUC (OR = 3.67, 95% CI: 1.20\u0026ndash;11.27, p = 0.023) were identified as independent predictors of post-operative UTI (Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePCNL remains the first-line treatment for staghorn and large renal calculi [1]. Despite its minimally invasive nature, it is associated with complications such as bleeding, infection, sepsis, and injury to adjacent organs [11]. Among these, sepsis stands out as a major cause of morbidity and mortality in stone disease [12]. Infectious complications can still occur in patients with sterile PMUC under antibiotic prophylaxis in PCNL [7]. Bacterial colonization within large kidney stones is believed to increase the risk of infection after surgery [7, 13]. Therefore, several studies have investigated whether RPUC and SC are more effective than PMUC in predicting postoperative SIRS or sepsis.\u003c/p\u003e\n\u003cp\u003eLi et al. reported the incidence of SIRS and urosepsis following PCNL to be approximately 21% and 6%, respectively. They also found SC positivity (21%) to be higher than PMUC (16%) and RPUC (10%) positivity [9]. Mariappan et al. reported SC positivity in 35.2% of cases, RPUC in 20.4%, and PMUC in 11.1% [4]. In our study, the incidence of UTI was 14.1%, and SC showed the highest culture positivity rate among UTI-positive patients (SC:39.4%, RPUC:30.3%, PMUC:27.3%). Notably, SC and RPUC growth was also detected in some patients without postoperative UTI (SC:8%, RPUC:6%).\u003c/p\u003e\n\u003cp\u003eThe predictive value of different culture types in postoperative UTI has been previously evaluated. Li et al. found SC positivity to be more strongly associated with SIRS than PMUC or RPUC [9]. Patients with positive SC had a fivefold higher risk of postoperative infection (OR:5.03, p=0.002) [14]. SC and RPUC have stronger predictive power for postoperative SIRS or sepsis compared to PMUC [7]. Patients with infected SC or RPUC have been found to have a fourfold higher risk of urosepsis (p=0.009) [4]. \u0026nbsp;In a meta-analysis by Zhou et al., positive PMUC (OR=3.16\u0026nbsp;95%CI 2.11-4.74), RPUC (OR=5.81, 95%CI 1.75\u0026ndash;19.32), and SC (OR=5.11, 95%CI: 1.46\u0026ndash;17.89) were all identified as predictors of post-PCNL infectious complications\u0026nbsp;[8]. Consistent with these findings, our multivariate analysis showed that intraoperative SC (OR=5.83, p=0.001) and RPUC (OR=3.67, p=0.023) as independent predictors of postoperative UTI and demonstrated a higher predictive value for infection complications after PCNL compared to PMUC (OR=1.32, p=0.65)\u0026nbsp;[4, 7]. \u0026nbsp;The lack of statistical significance for PMUC may be attributed to the administration of appropriate pre-operative antibiotic therapy in patients with positive results.\u003c/p\u003e\n\u003cp\u003eInterestingly, among patients diagnosed with post-operative UTI following infectious disease consultation, only 15.2% had positive growth in urine cultures obtained before the initiation of antibiotic treatments. The low culture positivity rate may be related to previous empirical/ prophylaxis antibiotic use or low bacterial load at the time of sampling. Given the limited utility of post-operative urine cultures in identifying causative pathogens, intra-operative SC and RPUC cultures are more valuable for guiding early and effective treatment.\u003c/p\u003e\n\u003cp\u003eEarly intervention is critical in patients with sepsis to reduce morbidity and mortality [15]. Initiation of appropriate antibiotic is essential in patients with UTI. Given the delay in obtaining culture results, intraoperative SC and RPUC may facilitate early targeted treatment and improve outcomes in patients with sepsis [16]. Therefore, it is recommended to routinely obtain SC and RPUC during PCNL procedures whenever possible [7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCulture positivity is an independent risk factor for infectious complications after PCNL. Thus, ensuring sterile urine before surgery and administering appropriate antibiotics in cases where sterility cannot be achieved is crucial [1]. However, various patient-related, stone-related or surgical parameters were also evaluated for infective complications after PCNL and conflicting results are observed in the literature.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe role of gender in post-PCNL infections remains controversial. While some studies report no significant association between gender and infection risk [9, 17, 18], Değirmenci et al. observed a higher SIRS rate in male patients [19]. However, female patients are more likely to have positive urine cultures than males (42.9% vs. 21.5%, p\u0026lt;0.01) [20]. Zhu et al. reported a possible association between female sex and increased rates of urosepsis [5]. Similarly, Zhou et al. reported that female gender increased the risk of infectious complications by more than 1.5 times (OR = 1.60, 95% CI 1.23\u0026ndash;2.07) [8]. Our study also showed that the proportion of female patients was significantly higher in the postoperative UTI group (60.6% vs. 28.4%, p=0.001), and multivariate analysis confirmed that female gender is an independent predictor of postoperative UTI (OR=3.71, p=0.004).\u003c/p\u003e\n\u003cp\u003eStone burden may be associated with an increased risk of urosepsis. While Rivera et al. found no significant correlation between stone size and postoperative infections, they reported a higher incidence of UTI in patients with multiple stones [17]. In our study, patients in the postoperative UTI group had a higher median stone number (3 [IQR 1\u0026ndash;4] vs. 2 [IQR 1\u0026ndash;3], p=0.024); however, stone size did not differ significantly between the groups, and multivariate analysis did not identify stone number as an independent risk factor for postoperative UTI.\u003c/p\u003e\n\u003cp\u003eThe association between OT and infection is also debated. Some studies report no significant relationship [9, 17], while others have identified OT as an independent risk factor [5, 8, 21]. In our study, the median OT was slightly longer in the UTI group (130 [IQR 102\u0026ndash;180] vs 120 [IQR 90\u0026ndash;150] minutes); however, this difference was not statistically significant (p=0.172), and OT was not identified as an independent predictor in the multivariate analysis. In line with earlier studies, our findings revealed no significant association between age, BMI, or diabetes and the development of postoperative urinary tract infection [9, 17, 21].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIncreased intrarenal pressure during PCNL may lead to systemic bacterial translocation through tubular, lymphatic, and venous backflow [13]. Smaller tract sizes may be associated with higher intrapelvic pressures and increased risk of postoperative infection [6]. However, we found no significant association between Amplatz sheath size and infectious complications.\u003c/p\u003e\n\u003cp\u003eA randomized prospective study by Sener et al. found no difference in infection parameters between patients with and without a postoperative foley catheter following ureterorenoscopy [22]. However, to our knowledge, there are no high-level evidence studies evaluating the impact of postoperative foley catheter use on infections after PCNL. In our study, postoperative Foley catheter placement was more common in the group with UTI (33.5% vs. 21.9%), but this difference was not statistically significant (p = 0.151) and was not identified as an independent predictor in multivariate analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, its retrospective design may have introduced selection and information bias. Second, the analysis was conducted at a single tertiary referral center, which may limit the generalizability of the findings to other institutions or populations with different microbiological flora or surgical protocols. Third, although we used multivariate logistic regression to adjust for confounding factors, unmeasured variables such as stone composition, antibiotic resistance profiles, or intraoperative irrigation pressures may have influenced the outcomes.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIntraoperative stone and renal pelvic urine culture demonstrated superior predictive value for postoperative urinary tract infection after supine percutaneous nephrolithotomy compared with preoperative midstream urine culture. Female sex and higher ASA scores were identified as independent risk factors for postoperative infection. In UTI-positive patients, pathogen identification was also more limited in postoperative urine cultures obtained before antibiotic therapy, particularly when compared with intraoperative cultures. Routine use of intraoperative cultures may facilitate earlier identification of causative organisms and enable rapid initiation of targeted antibiotic therapy, thus potentially reducing the risk of infectious complications and improving patient outcomes. These findings support routine use of intraoperative cultures in all supine PCNL patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e No conflict declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval of the research protocol by an Institutional Reviewer Board (IRB):\u003c/strong\u003e The study protocol was reviewed and approved by the Institutional Review Board (IRB) of Marmara University, School of Medicine (Approval No: 09.2025.25-0192).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e This study was conducted retrospectively using previously collected and anonymized data from the PCNL Database; therefore, obtaining written informed consent from participants was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistry and the Registration No. of the study/trial:\u0026nbsp;\u003c/strong\u003eN/A. This is a retrospective study and registration is not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData, Material and/or Code Availability:\u0026nbsp;\u003c/strong\u003eThe datasets, materials, and/or code generated and/or analyzed during the current study are not publicly available. However, they may be made available from the corresponding author on reasonable scientific request due to valid academic or ethical considerations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eThe use of artificial intelligence:\u0026nbsp;\u003c/strong\u003eArtificial intelligence (AI) tools were utilized solely for the purpose of language translation. All analysis, and manuscript writing were performed by the authors without AI assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch conception and design:\u003c/strong\u003e GO, HKC\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData acquisition:\u003c/strong\u003e OBD, DD, EG, YS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u0026nbsp;\u003c/strong\u003eGO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis and interpretation:\u003c/strong\u003e GO, TES\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDrafting of the manuscript:\u0026nbsp;\u003c/strong\u003eGO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCritical revision of the manuscript:\u003c/strong\u003e HKC, TES\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdministrative, technical, or material support:\u003c/strong\u003e GO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e HKC, TES\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eApproval of the final manuscript:\u003c/strong\u003e all authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSkolarikos A (Chair), Neisius HJ,A, Petř\u0026iacute;k A, Kamphuis GM, Davis NF, Somani B, Tailly T, Lardas M, Gambaro G (Consultant nephrologist) JA Sayer (Consultant nephrologist) Guidelines Associates: R. Geraghty R, Lombardo L Tzelves Guidelines Office: C. Bezuidenhout. (2025) [cited 2025\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeitz C et al (2012) Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 61(1):146\u0026ndash;158\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGravas S et al (2012) Postoperative infection rates in low risk patients undergoing percutaneous nephrolithotomy with and without antibiotic prophylaxis: a matched case control study. J Urol 188(3):843\u0026ndash;847\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMariappan P et al (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173(5):1610\u0026ndash;1614\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu Z et al (2020) The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy. World J Urol 38(10):2629\u0026ndash;2636\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu C et al (2017) Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy. Kaohsiung J Med Sci 33(1):36\u0026ndash;43\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu M et al (2021) Preoperative Midstream Urine Cultures vs Renal Pelvic Urine Culture or Stone Culture in Predicting Systemic Inflammatory Response Syndrome and Urosepsis After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. J Endourol 35(10):1467\u0026ndash;1478\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou G et al (2022) The influencing factors of infectious complications after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 51(1):17\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Y, Xie L, Liu C (2024) Prediction of systemic inflammatory response syndrome and urosepsis after percutaneous nephrolithotomy by urine culture, stone culture, and renal pelvis urine culture: Systematic review and meta-analysis. Heliyon 10(13):e33155\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchnabel MJ, Wagenlehner FME, Schneidewind L (2019) Perioperative antibiotic prophylaxis for stone therapy. Curr Opin Urol 29(2):89\u0026ndash;95\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaylor E et al (2012) Complications associated with percutaneous nephrolithotomy. Transl Androl Urol 1(4):223\u0026ndash;228\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhitehurst L, Jones P, Somani BK (2019) Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review. World J Urol 37(5):759\u0026ndash;776\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKreydin EI, Eisner BH (2013) Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10(10):598\u0026ndash;605\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZheng J et al (2025) Is it necessary for patients with a positive urine culture to achieve a negative result after antimicrobial treatment before undergoing percutaneous nephrolithotomy? World J Urol 43(1):131\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu Y et al (2018) Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. J Intensive Care Med 33(5):296\u0026ndash;309\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh I et al (2019) Efficacy of Intraoperative Renal Stone Culture in Predicting Postpercutaneous Nephrolithotomy Urosepsis/Systemic Inflammatory Response Syndrome: A Prospective Analytical Study with Review of Literature. J Endourol 33(2):84\u0026ndash;92\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRivera M et al (2016) Pre- and Postoperative Predictors of Infection-Related Complications in Patients Undergoing Percutaneous Nephrolithotomy. J Endourol 30(9):982\u0026ndash;986\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKorets R et al (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186(5):1899\u0026ndash;1903\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDegirmenci T et al (2019) Does leaving residual fragments after percutaneous nephrolithotomy in patients with positive stone culture and/or renal pelvic urine culture increase the risk of infectious complications? Urolithiasis 47(4):371\u0026ndash;375\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu J et al (2020) Does preoperative urine culture still play a role in predicting post-PCNL SIRS? A retrospective cohort study. Urolithiasis 48(3):251\u0026ndash;256\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePuia D et al (2023) Can we identify the risk factors for SIRS/sepsis after percutaneous nephrolithotomy? A meta\u0026ndash;analysis and literature review. Exp Ther Med 25(3):110\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSener TE et al (2025) Foley catheter after ureteroscopy and JJ stent placement: a randomised prospective European Association of Urology Section of Urolithiasis-Young Academic Urologists (EULIS-YAU) endourology study. BJU Int 135(1):95\u0026ndash;102\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline Demographics and Stone Characteristics by UTI Status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUTI (-)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=201 (85.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUTI (+)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=33 (14.1%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e46.8 (\u0026plusmn;16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e48.9 (\u0026plusmn;17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e27.1 (\u0026plusmn;5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e27.4 (\u0026plusmn;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e0.764\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender, n (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e144 (71.6)\u003c/p\u003e\n \u003cp\u003e57 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e13 (39.4)\u003c/p\u003e\n \u003cp\u003e20 (60.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e159 (79.1)\u003c/p\u003e\n \u003cp\u003e42 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e28 (84.8)\u003c/p\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA-1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eASA-2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eASA-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e98 (48.8)\u003c/p\u003e\n \u003cp\u003e97 (48.3)\u003c/p\u003e\n \u003cp\u003e6 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e13 (39.4)\u003c/p\u003e\n \u003cp\u003e13 (39.4)\u003c/p\u003e\n \u003cp\u003e7 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery side, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight side\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLeft side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e110 (54.7)\u003c/p\u003e\n \u003cp\u003e91 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e19 (57.6)\u003c/p\u003e\n \u003cp\u003e14 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e0.760\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-op urinary diversion, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDouble-J stent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNephrostomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e162 (80.6)\u003c/p\u003e\n \u003cp\u003e30 (14.9)\u003c/p\u003e\n \u003cp\u003e9 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e24 (72.7)\u003c/p\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of stones\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e3 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple stones, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e83 (41.3)\u003c/p\u003e\n \u003cp\u003e118 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e9 (27.3)\u003c/p\u003e\n \u003cp\u003e24 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLargest stone size, mm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.7521%;\"\u003e\n \u003cp\u003e25.2 (21.5-31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4711%;\"\u003e\n \u003cp\u003e23 (20-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.3967%;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eContinuous variables were compared using the independent samples t-test or Mann\u0026ndash;Whitney U test based on distribution. Categorical variables were analyzed using the chi-square test or Fisher\u0026rsquo;s exact test where appropriate. A p value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eUTI: urinary tract infection; BMI: body mass index; ASA: American Society of Anesthesiologists; DJ stent: double-J stent; Fr: French; Pre-op: preoperative; Post-op: postoperative.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Operative and Postoperative Parameters by UTI Status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUTI (-)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=201 (85.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUTI (+)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=33 (14.1%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmplatz sheath size, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12/16 Fr\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e16/20 Fr\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e20/24 Fr\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e26/30 Fr\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e47 (23.4)\u003c/p\u003e\n \u003cp\u003e111 (55.2)\u003c/p\u003e\n \u003cp\u003e35 (17.4)\u003c/p\u003e\n \u003cp\u003e8 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003cp\u003e21 (63.6)\u003c/p\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003cp\u003e2 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of flexible ureteroscopy (ECIRS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e156 (77.6)\u003c/p\u003e\n \u003cp\u003e45 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e29 (87.9)\u003c/p\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-op urinary drainage, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDouble-J stent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNephrostomy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDouble-J stent + Nephrostomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e32 (15.9)\u003c/p\u003e\n \u003cp\u003e127 (63.2)\u003c/p\u003e\n \u003cp\u003e25 (12.4)\u003c/p\u003e\n \u003cp\u003e17 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003cp\u003e19 (57.6)\u003c/p\u003e\n \u003cp\u003e6 (18.2)\u003c/p\u003e\n \u003cp\u003e3 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-op foley catheter placement, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e157 (78.1)\u003c/p\u003e\n \u003cp\u003e44 (21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e22 (66.7)\u003c/p\u003e\n \u003cp\u003e11 (33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperation time, min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e120 (90-150)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e130 (102-180)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStone-free Status, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStone-free\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSingle residual fragment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple residual fragments\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e165 (82.1)\u003c/p\u003e\n \u003cp\u003e21 (10.4)\u003c/p\u003e\n \u003cp\u003e15 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e25 (75.8)\u003c/p\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFever, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e195 (97)\u003c/p\u003e\n \u003cp\u003e6 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e9 (27.3)\u003c/p\u003e\n \u003cp\u003e24 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-op urine culture positivity, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e186 (92.5)\u003c/p\u003e\n \u003cp\u003e15 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e24 (72.7)\u003c/p\u003e\n \u003cp\u003e9 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntra-op stone culture positivity, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e185 (92)\u003c/p\u003e\n \u003cp\u003e16 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e20 (60.6)\u003c/p\u003e\n \u003cp\u003e13 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntra-op renal pelvic culture positivity, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e189 (94)\u003c/p\u003e\n \u003cp\u003e12 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e23 (69.7)\u003c/p\u003e\n \u003cp\u003e10 (30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48.5099%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay, days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e2 (2-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7086%;\"\u003e\n \u003cp\u003e8 (7-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Continuous variables were compared using the independent samples t-test or Mann\u0026ndash;Whitney U test based on distribution. Categorical variables were analyzed using the chi-square test or Fisher\u0026rsquo;s exact test where appropriate. A p value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eUTI: urinary tract infection; BMI: body mass index; ASA: American Society of Anesthesiologists; DJ stent: double-J stent; Fr: French; Pre-op: preoperative; Post-op: postoperative.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTablo 3. Independent Predictors of Postoperative UTI\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (Exp(B))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003eGender (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e1.52-9.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003eASA-3 (vs ASA-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e1.19-22-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003ePresence of pre-op urinary diversion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e0.339-2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003eStone number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e0.94-1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003eUse of flexible ureteroscopy (ECIRS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e0.14-1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003eOperation time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e1.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e0.99-1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003ePost-op foley catheter placement (yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e0.79-5.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003ePre-op urine culture (PMUC) positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e0.4-4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003eIntra-op stone culture (SC) positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e5.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e1.99-17.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003eIntra-op renal pelvic culture (RPUC) positivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e1.2-11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53.1457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3642%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMultivariate logistic regression was performed for variables with p\u0026lt;0.25 in univariate analysis. Statistically significant variables are shown as p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003eUTI: urinary tract infection; OR: odds ratio; CI: confidence interval; Pre-op: preoperative; Intra-op: intraoperative.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Complications, Kidney calculi, Percutaneous nephrolithotomy, Urinary tract infections, Urine culture","lastPublishedDoi":"10.21203/rs.3.rs-7722932/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7722932/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e This study aimed to compare the predictive value of preoperative midstream urine culture (PMUC), intraoperative renal pelvic urine culture (RPUC), and stone culture (SC) for postoperative urinary tract infections (UTIs) following percutaneous nephrolithotomy (PCNL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe retrospectively analyzed 234 patients who underwent supine-PCNL between January 2020 and April 2025. UTI was diagnosed based on systemic inflammatory response syndrome criteria and elevated inflammatory markers. Demographic, peri-, intra- and post-operative data were compared between patients with and without UTI. Multivariate logistic regression identified independent predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eUTI occurred in 14.1%(n=33) of patients postoperatively, with 72.7% presenting with fever. Culture positivity rates were significantly higher in postoperative UTI-patients (PMUC=27.3%vs.7.5%, SC:39.4%vs.8.0% and RPUC:30.3%vs.6.0%; p\u0026lt;0.001). In UTI-patients, only 15.2% of postoperative urine cultures obtained before antibiotic treatment showed bacterial growth, which was lower than intraoperative cultures. UTI was higher in female patients (60.6% vs. 39.4%) and in those with an ASA score of 3 (p=0.001 and p=0.020). Female gender (OR=3.71, p=0.004), ASA-3 score (OR=5.13, p=0.029), positive SC (OR=5.83, p=0.001), and RPUC (OR=3.67, p=0.023) were independent predictors of postoperative UTI. PMUC was not associated (p = 0.65) with postoperative UTI in the multivariate analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eIntraoperative SC and RPUC are superior to PMUC in predicting UTI after supine PCNL and should be routinely obtained. Female gender and ASA-3 score are independent risk factors. In patients who develop UTI, prior empirical or prophylactic antibiotic use may limit pathogen detection in postoperative urine cultures; therefore, intraoperative cultures play a critical role in early and targeted treatment.\u003c/p\u003e","manuscriptTitle":"Comparison of Preoperative and Intraoperative Cultures for Predicting Postoperative Urinary Tract Infections Following Supine PCNL","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 02:22:50","doi":"10.21203/rs.3.rs-7722932/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-27T06:22:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-26T00:13:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-22T21:54:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155640709000059964920077567680159614713","date":"2025-10-08T05:30:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26317658505799736642245300886021568849","date":"2025-10-06T20:57:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-05T18:49:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-04T00:51:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-03T16:19:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2025-09-26T14:37:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"39d2bfca-b8a6-4c12-92a3-e975ba96ea6f","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:08:52+00:00","versionOfRecord":{"articleIdentity":"rs-7722932","link":"https://doi.org/10.1007/s00345-026-06320-5","journal":{"identity":"world-journal-of-urology","isVorOnly":false,"title":"World Journal of Urology"},"publishedOn":"2026-03-02 15:58:26","publishedOnDateReadable":"March 2nd, 2026"},"versionCreatedAt":"2025-10-17 02:22:50","video":"","vorDoi":"10.1007/s00345-026-06320-5","vorDoiUrl":"https://doi.org/10.1007/s00345-026-06320-5","workflowStages":[]},"version":"v1","identity":"rs-7722932","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7722932","identity":"rs-7722932","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}