Background Systemic inflammatory response syndrome (SIRS) is a dangerous complication after percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). We aimed to review the diagnostic accuracy of mid steam urine culture (MSUC), pelvic urine culture (PUC) and stone culture (SC) derived from the same cases to predict SIRS after PCNL and/or RIRS. Materials and methods A comprehensive literature search was performed, using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. Sensitivity and specificity were calculated for MSUC, PUC, and SC. The diagnostic odds ratio (DOR) was estimated for each study with a random effect and hierarchical summary receiver operating characteristic (HSROC) model leading to a corresponding 95% Confidence Interval (CI). Overall test accuracy was measured by finding the area under the curve (AUC). An AUC value >0.70 stands for adequate overall accuracy Results The search retrieved 537 papers. After screening, 21 studies involving 5238 patients were included for the meta-analysis. The pooled sensitivity for MSUC was 0.322 (95% CI 0.2228–0.432), and pooled specificity 0.854 (95% CI 0.810–0.889). The DOR was low at 2.780 (95% CI 1.769–4.368), showing poor overall diagnostic accuracy. The pooled sensitivity for PUC was 0.323 (95% CI 0.224–0.440) and specificity 0.931 (95% CI 0.896–0.954). The DOR was 6.377 (95% CI 4.065–10.004), showing a mild overall diagnostic accuracy. The pooled sensitivity for SC was 0.552 (95% CI 0.441–0.658) and specificity 0.847 (95%CI 0.798–0.886). The DOR was 6.820 (95%CI 4.435–10.488), showing mild overall diagnostic accuracy. The AUC for HSROC for MSUC was 0.65, 0.73, and 0.75 for PUC and SC, respectively. Conclusion MSUC is a poor predictor for postoperative SIRS. PUC or SC should be collected during lithotripsy to better predict the possibility of developing postoperative SIRS after PCNL and RIRS.

中文翻译：

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评估经皮肾镜取石术和逆行肾内手术后预测全身炎症反应综合征的最佳尿培养：系统评价和荟萃分析的结果。

背景 全身炎症反应综合征 (SIRS) 是经皮肾镜取石术 (PCNL) 和逆行肾内手术 (RIRS) 后的危险并发症。我们旨在回顾来自同一病例的中蒸汽尿培养 (MSUC)、盆腔尿培养 (PUC) 和结石培养 (SC) 的诊断准确性，以预测 PCNL 和/或 RIRS 后的 SIRS。材料和方法 使用 MEDLINE、EMBASE 和 Cochrane Central Controlled Register of Trials 进行了全面的文献检索。计算 MSUC、PUC 和 SC 的敏感性和特异性。使用随机效应和分层汇总接受者操作特征 (HSROC) 模型估计每项研究的诊断优势比 (DOR)，从而得出相应的 95% 置信区间 (CI)。通过找到曲线下面积 (AUC) 来测量总体测试准确性。AUC 值 >0.70 代表足够的总体准确度 结果 搜索检索到 537 篇论文。筛选后，涉及 5238 名患者的 21 项研究被纳入荟萃分析。MSUC 的汇总敏感性为 0.322 (95% CI 0.2228–0.432)，汇总特异性为 0.854 (95% CI 0.810–0.889)。DOR 低至 2.780（95% CI 1.769–4.368），表明总体诊断准确性较差。PUC 的汇总敏感性为 0.323 (95% CI 0.224–0.440) 和特异性 0.931 (95% CI 0.896–0.954)。DOR 为 6.377（95% CI 4.065–10.004），显示出轻微的总体诊断准确性。SC 的汇总敏感性为 0.552 (95% CI 0.441–0.658) 和特异性 0.847 (95% CI 0.798–0.886)。DOR 为 6.820 (95%CI 4.435–10.488)，显示出轻微的总体诊断准确性。MSUC 的 HSROC 的 AUC 分别为 PUC 和 SC 的 0.65、0.73 和 0.75。结论 MSUC 是术后 SIRS 的不良预测指标。碎石术期间应收集 PUC 或 SC，以更好地预测 PCNL 和 RIRS 后发生术后 SIRS 的可能性。