Analysis of Risk Factors and Construction of a Prediction Model for Preoperative Concurrent Pathogenic Pyuria in Patients With Ureteral Calculi

Abstract Background This study aims to analyze the risk factors for preoperative pyuria in patients with ureteral calculi (UC). On the basis of clarifying the presence of pyuria, it focuses on exploring the risk factors for concurrent pathogenic pyuria, and meanwhile constructs a simple and practical prediction model to assess the risk of its occurrence, so as to provide a reference basis for clinical early preoperative intervention in such patients. Methods From January 2019 to May 2025, a total of 1182 patients with UC were enrolled in this study. First, they were divided into a pyuria group and a nonpyuria group. Logistic regression analyses were used to screen out the risk factors associated with pyuria. To enhance the reliability and robustness of the results, a sensitivity analysis was further performed to verify the conclusions. Subsequently, the pyuria group was further divided into 2 subgroups, namely a pathogenic pyuria group and a sterile pyuria group. Using the same methods mentioned above, the relevant risk factors for preoperative concurrent pathogenic pyuria in patients with UC were identified, and a corresponding prediction model was constructed, which was then validated using receiver operating characteristic (ROC) curves and calibration curves. Results A total of 1182 patients with UC were enrolled in this study, including 250 cases (21.15%) receiving nonsurgical treatment and 932 cases (78.85%) undergoing surgical treatment. Among them, 630 cases (53.30%) were diagnosed with pyuria. Multivariate logistic regression analysis combined with sensitivity analysis showed that female gender (P = .005), bilateral UC (P = .007), stone size (P .05), and hydronephrosis size (P .05) were independent risk factors for preoperative pyuria in such patients. A further subgroup analysis was performed on 630 patients with pyuria, including 135 cases (21.43%) of pathogenic pyuria and 495 cases (78.57%) of sterile pyuria. Analysis using the same methods mentioned above showed that female gender (P .001), comorbid diabetes mellitus (P = .032), and hydronephrosis size 40 mm (P = .022) were independent risk factors for preoperative concurrent pathogenic pyuria in patients with UC. A prediction model was constructed by combining the above indicators with urinary white blood cells 60 per high-power field as predictive variables. The area under the ROC curve of this model was 0.764, indicating good predictive ability; the Hosmer–Lemeshow test (P = .989) showed good goodness of fit; and the calibration curve demonstrated good consistency of the model. Conclusions This study not only confirms that female gender, bilateral UC, stone size, and hydronephrosis size are independent risk factors for preoperative pyuria in patients with UC, but also further identifies that female gender, comorbid diabetes mellitus, and hydronephrosis size 40 mm are independent risk factors for preoperative concurrent pathogenic pyuria in such patients. The prediction model constructed accordingly can effectively assess the risk of preoperative concurrent pathogenic pyuria in female patients with UC, providing a practical reference basis for clinicians to implement early preoperative intervention in such patients.