Intraoperative renal collecting system damage increases risks of ipsilateral upper urinary tract stones after partial nephrectomy: a 1∶2 propensity-matched case-control study

doi:10.12122/j.issn.1673-4254.2025.09.08

Abstract

Abstract:

Objective To investigate the incidence of ipsilateral upper urinary tract stones after partial nephrectomy and its risk factors. Methods We retrospectively analyzed baseline patient characteristics (age, gender, and body mass index), smoking, alcohol consumption, comorbidities (hypertension, diabetes, hypertriglyceridemia, hyperuricemia, and cardiovascular diseases), preoperative tumor conditions (tumor diameter, multiple foci, location, hemorrhage, necrosis, cystic changes, and endophytic growth), preoperative glomerular filtration rate and intraoperative factors (renal collecting system damage, ischemia time, operation time, surgical approach, and estimated intraoperative blood loss) to identify the risk factors for ipsilateral upper urinary tract stones following partial nephrectomy in our center. Results The overall incidence of upper urinary tract stones following partial nephrectomy was 7.80% (112/1435). The incidence of ipsilateral upper urinary tract stones was significantly higher than those of contralateral stones (4.95% vs 1.46%, P<0.001) and bilateral stones (4.95% vs 1.39%, P<0.001). Intraoperative damage to the renal collecting system was identified as a significant risk factor for ipsilateral upper urinary tract stones (OR=4.550, 95% CI: 2.237-9.252, P<0.001). Diabetes was a probable risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy (OR=2.419, 95% CI: 0.973-6.012, P=0.057). Conclusions The incidence of ipsilateral upper urinary tract stones after partial nephrectomy is higher than that of contralateral and bilateral stones. Intraoperative renal collecting system damage is a risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy.

Key words: partial nephrectomy, urolithiasis, renal collecting system

Yanzhong LIU, Run ZHU, Yuzhu LI, Xin MA, Haixing MAI. Intraoperative renal collecting system damage increases risks of ipsilateral upper urinary tract stones after partial nephrectomy: a 1∶2 propensity-matched case-control study[J]. Journal of Southern Medical University, 2025, 45(9): 1880-1888.

Figures/Tables 10

Fig.1 Flow chart of the study.

Fig.2 Plot of the propensity score-matched study. A: Dot plot of standardized mean difference. B: Histogram of standardized mean differences (before and after).

Fig.3 Incidence, clinical features and treatment of ipsilateral and contralateral stones after partial nephrectomy. A: Number of new and accumulated patients with ipsilateral and contralateral upper urinary tract stones. B: Difference of maximum diameter between ipsilateral and contralateral upper urinary tract stones after operation. C: The treatment difference of ipsilateral and contralateral upper urinary tract stones after operation.

Tab.1 Clinical characteristics of patients with upper urinary tract stones after partial nephrectomy

Clinical characteristics	Patients with unilateral stones				Patients with bilateral stones
Clinical characteristics	Surgical side (n=71)	Non-surgical side (n=21)	T/ $χ 2$ /Z	P	Surgical side (n=20)	Non-surgical side (n=20)	T/ $χ 2$ /Z	P
Age (years, Mean±SD)	50.18±10.77	46.43±10.05	1.424^a	0.158	45.75±12.11	45.75±12.11
BMI (Mean±SD)	27.00±3.68	26.2±3.50	0.891^a	0.375	26.17±4.57	26.17±4.57
Gender [n (%)]			1.840^b	0.205
Male	60 (84.51)	15 (71.43)			16 (80.00)	16 (80.00)
Female	11 (15.49)	6 (28.57)			4 (20.00)	4 (20.00)
Maximum diameter (mm)	3 (2-18)	3 (2-8)	-2.140^c	0.032	2 (2-20)	2.5 (2-19)	1.296^c	0.195
Maximum diameter >6 mm [n (%)]			7.411^b	0.005			0.784^b	0.661
Yes	25 (35.21)	1 (4.76)			2 (10.00)	4 (20.00)
No	46 (64.79)	20 (95.24)			18 (90.00)	16 (80.00)
Surgical treatment [n (%)]			6.418^b	0.011			0.229^b	1.000
Yes	23 (32.39)	1 (4.76)			2 (10.00)	3 (15.00)
No	48 (67.61)	20 (95.24)			18 (80.00)	17 (85.00)

Tab.1 Clinical characteristics of patients with upper urinary tract stones after partial nephrectomy

Clinical characteristics	Patients with unilateral stones				Patients with bilateral stones
Clinical characteristics	Surgical side (n=71)	Non-surgical side (n=21)	T/ $χ 2$ /Z	P	Surgical side (n=20)	Non-surgical side (n=20)	T/ $χ 2$ /Z	P
Age (years, Mean±SD)	50.18±10.77	46.43±10.05	1.424^a	0.158	45.75±12.11	45.75±12.11
BMI (Mean±SD)	27.00±3.68	26.2±3.50	0.891^a	0.375	26.17±4.57	26.17±4.57
Gender [n (%)]			1.840^b	0.205
Male	60 (84.51)	15 (71.43)			16 (80.00)	16 (80.00)
Female	11 (15.49)	6 (28.57)			4 (20.00)	4 (20.00)
Maximum diameter (mm)	3 (2-18)	3 (2-8)	-2.140^c	0.032	2 (2-20)	2.5 (2-19)	1.296^c	0.195
Maximum diameter >6 mm [n (%)]			7.411^b	0.005			0.784^b	0.661
Yes	25 (35.21)	1 (4.76)			2 (10.00)	4 (20.00)
No	46 (64.79)	20 (95.24)			18 (90.00)	16 (80.00)
Surgical treatment [n (%)]			6.418^b	0.011			0.229^b	1.000
Yes	23 (32.39)	1 (4.76)			2 (10.00)	3 (15.00)
No	48 (67.61)	20 (95.24)			18 (80.00)	17 (85.00)

Tab.2 Analysis of the differences in age, gender and BMI of the patients before and after matching

Item	Before matched					After matched
Item	Total (n=1394)	Control group (n=1323)	Case group (n=71)	t/ $χ 2$	P	Total (n=207)	Control group (n=138)	Case group (n=69)	t/ $χ 2$	P
Age (year)	52.13±11.41	52.23±11.44	50.18±10.77	1.474	0.141	49.86±11.49	49.54±11.88	50.49±10.74	-0.559	0.577
BMI	25.95±3.43	25.89±3.41	27.01±3.68	-2.679	0.007	26.51±3.39	26.40±3.46	26.72±3.27	-0.635	0.526
Gender				5.502	0.019				0.076	0.783
Male	1009(72.38)	949 (71.73)	60 (84.51)			176 (85.02)	118 (85.51)	58 (84.06)
Female	385 (27.62)	374 (28.27)	11 (15.49)			31 (14.98)	20 (14.49)	11 (15.94)

Tab.2 Analysis of the differences in age, gender and BMI of the patients before and after matching

Item	Before matched					After matched
Item	Total (n=1394)	Control group (n=1323)	Case group (n=71)	t/ $χ 2$	P	Total (n=207)	Control group (n=138)	Case group (n=69)	t/ $χ 2$	P
Age (year)	52.13±11.41	52.23±11.44	50.18±10.77	1.474	0.141	49.86±11.49	49.54±11.88	50.49±10.74	-0.559	0.577
BMI	25.95±3.43	25.89±3.41	27.01±3.68	-2.679	0.007	26.51±3.39	26.40±3.46	26.72±3.27	-0.635	0.526
Gender				5.502	0.019				0.076	0.783
Male	1009(72.38)	949 (71.73)	60 (84.51)			176 (85.02)	118 (85.51)	58 (84.06)
Female	385 (27.62)	374 (28.27)	11 (15.49)			31 (14.98)	20 (14.49)	11 (15.94)

Tab.3 General and perioperative data of the patientsafter partial nephrectomy (after propensity score matching)

Variable		Control group after matching (n=138)	Case group after matching (n=69)	T/ $χ 2$ /Z	P
Tumor size (cm)		2.93±1.10	2.72±1.04	1.296^a	0.196
Multiple tumors	Yes	1 (0.72)	1 (1.45)	0.252^b	0.615
Multiple tumors	No	137 (99.28)	68 (98.55)	0.252^b	0.615
Operation time (min)		130.00 (95.75, 155.00)	120.00 (91.50, 148.50)	-1.110^c	0.267
Tumor location	Left	67 (48.55)	40 (57.97)	1.635^b	0.201
Tumor location	Right	71 (51.45)	29 (42.03)	1.635^b	0.201
Tumor hemorrhage	Yes	71 (51.45)	26 (37.68)	3.502^b	0.061
Tumor hemorrhage	No	67 (48.55)	43 (62.32)	3.502^b	0.061
Tumor cystic change	Yes	47 (34.06)	21 (30.43)	0.274^b	0.601
Tumor cystic change	No	91 (65.94)	48 (69.57)	0.274^b	0.601
Tumor necrosis	Yes	9 (6.52)	4 (5.80)	0.041^b	0.839
Tumor necrosis	No	129 (93.48)	65 (94.20)	0.041^b	0.839
Diabetes	Yes	15 (10.87)	12 (17.39)	1.725^b	0.189
Diabetes	No	123 (89.13)	57 (82.61)	1.725^b	0.189
Ardiovascular diseases	Yes	9 (6.52)	2 (2.90)	1.200^b	0.273
Ardiovascular diseases	No	129 (93.48)	67 (97.10)	1.200^b	0.273
Hypertension	Yes	39 (28.26)	16 (23.19)	0.607^b	0.436
Hypertension	No	99 (71.74)	53 (76.81)	0.607^b	0.436
Smoke	Yes	21 (15.22)	11 (15.94)	0.018^b	0.892
Smoke	No	117 (84.78)	58 (84.06)	0.018^b	0.892
Drink	Yes	22 (15.94)	7 (10.14)	1.283^b	0.257
Drink	No	116 (84.06)	62 (89.86)	1.283^b	0.257
Hematuria	Yes	5 (3.62)	3 (4.35)	0.065^b	0.799
Hematuria	No	133 (96.38)	66 (95.65)	0.065^b	0.799
Endogenous tumor	Yes	86 (62.77)	40 (57.97)	0.446^b	0.504
Endogenous tumor	No	51 (37.23)	29 (42.03)	0.446^b	0.504
RPCI	Yes	58 (42.34)	52 (75.36)	20.110^b	<0.001
RPCI	No	79 (57.66)	17 (24.64)	20.110^b	<0.001
Hyperlipidemia	Yes	48 (34.78)	23 (33.33)	0.043^b	0.836
Hyperlipidemia	No	90 (65.22)	46 (66.67)	0.043^b	0.836
Hyperuricemia	Yes	22 (15.94)	13 (18.84)	0.275^b	0.600
Hyperuricemia	No	116 (84.06)	56 (81.16)	0.275^b	0.600
Surgical method	Robot-assisted	66 (47.83)	30 (43.48)	0.350^b	0.554
Surgical method	Laparoscopy	72 (52.17)	39 (56.52)	0.350^b	0.554
Estimated intraoperative blood loss (mL)		50.00 (20.00, 80.00)	50.00 (20.00, 50.00)	-0.284^c	0.776
Renal ischemia-reperfusion time (min)		19.90±7.42	20.03±7.67	-0.116^a	0.908
Glomerular filtration rate (mL/min)		103.78±8.69	102.58±7.45	1.032^a	0.304

Tab.3 General and perioperative data of the patientsafter partial nephrectomy (after propensity score matching)

Variable		Control group after matching (n=138)	Case group after matching (n=69)	T/ $χ 2$ /Z	P
Tumor size (cm)		2.93±1.10	2.72±1.04	1.296^a	0.196
Multiple tumors	Yes	1 (0.72)	1 (1.45)	0.252^b	0.615
Multiple tumors	No	137 (99.28)	68 (98.55)	0.252^b	0.615
Operation time (min)		130.00 (95.75, 155.00)	120.00 (91.50, 148.50)	-1.110^c	0.267
Tumor location	Left	67 (48.55)	40 (57.97)	1.635^b	0.201
Tumor location	Right	71 (51.45)	29 (42.03)	1.635^b	0.201
Tumor hemorrhage	Yes	71 (51.45)	26 (37.68)	3.502^b	0.061
Tumor hemorrhage	No	67 (48.55)	43 (62.32)	3.502^b	0.061
Tumor cystic change	Yes	47 (34.06)	21 (30.43)	0.274^b	0.601
Tumor cystic change	No	91 (65.94)	48 (69.57)	0.274^b	0.601
Tumor necrosis	Yes	9 (6.52)	4 (5.80)	0.041^b	0.839
Tumor necrosis	No	129 (93.48)	65 (94.20)	0.041^b	0.839
Diabetes	Yes	15 (10.87)	12 (17.39)	1.725^b	0.189
Diabetes	No	123 (89.13)	57 (82.61)	1.725^b	0.189
Ardiovascular diseases	Yes	9 (6.52)	2 (2.90)	1.200^b	0.273
Ardiovascular diseases	No	129 (93.48)	67 (97.10)	1.200^b	0.273
Hypertension	Yes	39 (28.26)	16 (23.19)	0.607^b	0.436
Hypertension	No	99 (71.74)	53 (76.81)	0.607^b	0.436
Smoke	Yes	21 (15.22)	11 (15.94)	0.018^b	0.892
Smoke	No	117 (84.78)	58 (84.06)	0.018^b	0.892
Drink	Yes	22 (15.94)	7 (10.14)	1.283^b	0.257
Drink	No	116 (84.06)	62 (89.86)	1.283^b	0.257
Hematuria	Yes	5 (3.62)	3 (4.35)	0.065^b	0.799
Hematuria	No	133 (96.38)	66 (95.65)	0.065^b	0.799
Endogenous tumor	Yes	86 (62.77)	40 (57.97)	0.446^b	0.504
Endogenous tumor	No	51 (37.23)	29 (42.03)	0.446^b	0.504
RPCI	Yes	58 (42.34)	52 (75.36)	20.110^b	<0.001
RPCI	No	79 (57.66)	17 (24.64)	20.110^b	<0.001
Hyperlipidemia	Yes	48 (34.78)	23 (33.33)	0.043^b	0.836
Hyperlipidemia	No	90 (65.22)	46 (66.67)	0.043^b	0.836
Hyperuricemia	Yes	22 (15.94)	13 (18.84)	0.275^b	0.600
Hyperuricemia	No	116 (84.06)	56 (81.16)	0.275^b	0.600
Surgical method	Robot-assisted	66 (47.83)	30 (43.48)	0.350^b	0.554
Surgical method	Laparoscopy	72 (52.17)	39 (56.52)	0.350^b	0.554
Estimated intraoperative blood loss (mL)		50.00 (20.00, 80.00)	50.00 (20.00, 50.00)	-0.284^c	0.776
Renal ischemia-reperfusion time (min)		19.90±7.42	20.03±7.67	-0.116^a	0.908
Glomerular filtration rate (mL/min)		103.78±8.69	102.58±7.45	1.032^a	0.304

Tab.4 Conditional regression analyses of secondary operative renal ureteral calculi in patients after partial nephrectomy (after propensity score matching)

Variable	Univariate analysis			Multivariate analysis
Variable	P	OR	95% CI	P	OR	95% CI
Tumor size (cm)	0.182	0.821	0.615-1.096
Multiple tumors	0.624	2.000	0.125-31.975
Operation time (min)	0.222	0.996	0.989-1.003
Tumor location	0.182	0.66	0.358-1.215
Tumor hemorrhage	0.072	0.584	0.325-1.050	0.160	0.629	0.329-1.201
Tumor cystic change	0.586	0.835	0.436-1.599
Tumor necrosis	0.845	0.889	0.274-2.886
Diabetes	0.208	1.669	0.753-3.700	0.057	2.419	0.973-6.012
Ardiovascular diseases	0.277	0.415	0.085-2.025
Hypertension	0.429	0.76	0.385-1.501
Smokeing	0.894	1.055	0.483-2.303
Drinking	0.289	0.627	0.264-1.487
Hematuria	0.803	1.2	0.287-5.021
Endogenous tumor	0.523	0.816	0.438-1.522
RPCI	<0.001	4.103	2.110-7.978	<0.001	4.550	2.237-9.252
Hyperlipidemia	0.819	0.924	0.470-1.815	0.964	0.982	0.444-2.173
Hyperuricemia	0.580	1.257	0.559-2.825	0.493	1.398	0.536-3.650
Surgical method	0.545	1.203	0.661-2.190
Estimated intraoperative blood loss (mL)	0.544	0.999	0.996-1.002
Renal ischemia-reperfusion time (min)	0.907	1.002	0.964-1.042
Glomerular filtration rate (mL/min)	0.333	0.983	0.948-1.018

Tab.5 Subgroup analysis of tumor size

Variable	Tumor size≤3 cm			Tumor size>3 cm
Variable	P	OR	95% CI	P	OR	95% CI
Tumor hemorrhage	0.215	0.612	0.282-1.330	0.373	0.590	0.184-1.885
Diabetes	0.014	3.820	1.317-11.078	0.173	0.204	0.021-2.010
Hyperlipidemia	0.988	1.007	0.420-2.411	0.776	1.192	0.356-3.985
Hyperuricemia	0.294	1.837	0.590-5.718	0.827	1.165	0.296-4.580
RPCI	0.001	4.001	1.761-9.091	0.001	9.913	2.440-40.279

Tab.6 Subgroup analysis of endogenous tumor growth

Variable	Endogenous tumor			Tumor outreach
Variable	P	OR	95% CI	P	OR	95% CI
Tumor hemorrhage	0.069	0.469	0.208-1.061	0.813	0.880	0.306-2.535
Diabetes	0.332	1.731	0.572-5.241	0.129	3.430	0.699-16.825
Hyperlipidemia	0.630	1.239	0.519-2.958	0.994	1.004	0.295-3.421
Hyperuricemia	0.773	1.174	0.395-3.492	0.453	1.735	0.412-7.313
RPCI	0.005	3.747	1.478-9.501	<0.001	8.718	2.883-26.362

Tab.7 Subgroup analysis of surgical approaches

Variable	Robot-assisted			Laparoscopy
Variable	P	OR	95% CI	P	OR	95% CI
Tumor hemorrhage	0.720	0.842	0.330-2.150	0.147	0.396	0.159-1.089
Diabetes	0.067	3.616	0.914-14.315	0.704	1.273	0.365-4.438
Hyperlipidemia	0.390	1.578	0.558-4.463	0.310	0.602	0.227-1.601
Hyperuricemia	0.267	1.919	0.608-6.061	0.756	1.235	0.327-4.655
RPCI	0.012	3.784	1.348-10.622	0.000	5.604	2.254-13.932

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