Analysis of preoperative risk factors for clinical decision-making in female upper urinary tract stones: a retrospective cohort study

To identify independent risk factors that can be used for the preoperative prediction of treatment complexity in female patients with upper urinary tract stones, thereby providing a basis for clinical decision-making. This single-center retrospective cohort study consecutively enrolled 219 female patients with upper urinary tract stones admitted to the Department of Urology between January 2024 and May 2025. Based on the occurrence of treatment complexity (including: ① preoperative ureteral stent placement due to infection or obstruction; ② ≥3 stone-related readmissions within 12 months; ③ hospital stay > 6 days), patients were categorized into a complex course group (n = 107) and a control group (n = 112). Preoperative clinical data were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Statistical analysis was performed using SPSS version 25.0. An exploratory preoperative risk stratification framework was proposed based on the results of multivariate analysis. Univariate analysis revealed significant differences between the two groups in age (P = 0.008), stone location (P < 0.001), stone area (P = 0.039), presence of bacteria/fungi (P < 0.001), acute renal insufficiency (P < 0.001), high-sensitivity C-reactive protein (hs-CRP) level (P = 0.001), procalcitonin (PCT) level (P < 0.001), body mass index (BMI), history of previous urological surgery, ureteral stenosis, bilateral stones, comorbid diabetes, hypertension, fatty liver, white blood cell count, absolute neutrophil count, and neutrophil percentage. Multivariate analysis identified four independent risk factors: [1] Stone location (using ureteral stones as reference, renal stones: OR = 6.67, 95% CI: 2.67–16.68, renal-ureteral stones: OR = 3.37, 95% CI: 1.29–8.80) [2]. Bacterial/fungal infection (OR = 3.30, 95% CI: 1.42–7.62) [3]. hs-CRP level (OR = 1.01, 95% CI: 1.00-1.02) [4]. PCT level (OR = 1.12, 95% CI: 1.01–1.23). Based on these findings, an exploratory preoperative risk stratification framework was proposed. In this framework, bacterial/fungal infection and renal stone location were categorized as high-risk factors, while hs-CRP ≥ 7.3 mg/L and PCT ≥ 0.65 ng/mL were categorized as intermediate-risk factors, pending external validation. Bacterial/fungal infection, stone location (renal stones), elevated hs-CRP, and elevated PCT are effective preoperative predictors of treatment complexity in female patients with upper urinary tract stones. The proposed exploratory risk stratification framework may aid in the identification of high-risk patients and offers preliminary evidence to support individualized surgical strategies and perioperative management plans, though prospective validation is required before clinical implementation.