Assessment of Postoperative Complication Risk in Patients with Renal and Ureteral Stones Treated with Transurethral Ureteroscopy Holmium Laser Lithotripsy Based on WBC Levels

doi:10.3969/j.issn.1674-3245.2025.04.035

Abstract：Objective To evaluate the risk of postoperative complications in patients with renal and ureteral stones treated with transurethral ureteroscopy holmium laser lithotripsy (HLL). Methods A retrospective study was conducted on 111 patients with renal and ureteral stones who underwent HLL at Luixian County People's Hospital from January 2022 to June 2024. Data within one month of follow-up were collected. According to whether complications occurred, patients were divided into a complication group (31 cases) and a non-complication group (80 cases). Logistic regression analysis, receiver operating characteristic (ROC) curves, and subgroup analysis were used to explore the risk factors for postoperative complications. Results Among the 111 patients, 31 developed complications, with an incidence rate of 27.93%. Among them, 19 cases had stone migration, 2 cases had postoperative fever, 3 cases had pain, 5 cases had urinary tract infection, 2 cases had ureteral tearing or rupture, and 4 cases had double-J (DJ) stent displacement. Compared with the non-complication group, the complication group showed statistically significant differences in male proportion, hospitalization duration, stone location, stone CT value, preoperative urine culture positivity, operation time, and preoperative white blood cell (WBC) levels (P < 0.05). The logistic regression model showed that stone diameter, size, CT value, and preoperative WBC level were independent risk factors for postoperative complications (P < 0.05). Using postoperative complications as the dependent variable, ROC curve analysis showed that the area under the curve (AUC) for preoperative WBC level was 0.813 [(95% CI: 0.702–0.923), P < 0.001], with a sensitivity of 0.796 and specificity of 0.733. The cutoff value was 12.89 × 10^9/L. Using 12.89 × 10^9/L as the threshold, based on a two-segment logistic analysis model, the P-value of the log-likelihood ratio was less than 0.05. According to the subgroup analysis by threshold, compared with patients with lower WBC levels, those with higher WBC levels showed significant interactions with preoperative urine culture positivity, stone location, and hospitalization duration (P < 0.05). Conclusion The incidence of postoperative complications within one year after HLL was 27.93%. Stone diameter, size, CT value, and preoperative WBC level are independent risk factors for postoperative complications. Preoperative WBC levels showed good predictive performance, with a threshold of 12.89 × 10^9/L. High WBC levels showed significant interaction with preoperative urine culture positivity, stone location, and hospitalization duration. Clinically, it is essential to actively control preoperative WBC levels to reduce the risk of postoperative complications.