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ORIGINAL ARTICLE
Year : 2020  |  Volume : 31  |  Issue : 3  |  Page : 115-121

A lower urine white blood cell median can be a predictor of undiscovered urolithiasis in patients with acute urinary tract symptoms


1 Department of Surgery, Division of Urology, Cardinal Tien Hospital, Taipei, Taiwan
2 Department of Surgery, Division of Urology, Cardinal Tien Hospital; Department of Surgery, Division of Urology, Fu Jen Catholic University Hospital, Taipei, Taiwan
3 Department of Surgery, Division of Urology, Cardinal Tien Hospital; Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan

Correspondence Address:
Hsu-Che Huang
Department of Surgery, Division of Urology, Cardinal Tien Hospital, No. 362, Zhongzheng Road, Xindian, New Taipei City 23148
Taiwan
Yu-Wei Chou
No. 362, Zhongzheng Road, Xindian, New Taipei City 23148
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/UROS.UROS_12_20

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Purpose: Acute urinary tract infection (UTI) causes symptoms including urgency, frequency, dysuria, and pain in the lower urinary tract. However, these symptoms are not unique to infection. Urolithiasis, injury, neurological disease, and malignancy present with the same symptoms. We aimed to find predictors in urinalysis to detect underlying causes in patients with acute UTI symptoms. Materials and Methods: We recruited 192 patients who presented with acute UTI symptoms from a single institute between September 2012 and September 2018. Each patient received urinalysis, kidney–ureter–bladder X-ray, and kidney plus transabdominal bladder sonography as primary surveys. Patients with flank pain and hydronephrosis but without definitive radiopaque lesion received computed tomography (CT) scan as an advanced intervention. Cystoscopy was ordered by the physician if the patient had gross hematuria and was suspected to have intravesical lesion. We correlated the urine nitrate, the median of red blood cells (RBCs) and white blood cells (WBCs), and the ratio of red and WBCs with the finding on image studies, which included sonography, X-ray, and CT by statistical models. Results: In patients with urolithiasis detected by either X-ray or CT, logistic regression showed that higher urine RBC and lower urine WBC medians were predictors of urolithiasis. In the ROC analysis, WBC median lower than 7.75 per high power field (HPF) was a significant predicting factor for the positive finding of urolithiasis on a CT scan. Conclusion: When presenting with acute UTI symptoms, patients with a lower urine WBC median are correlated with a higher probability to have urolithiasis. In addition, WBC median lower than 7.75 per HPF in urinalysis is a predictor for urolithiasis found on CT in patients with flank pain or hydronephrosis.


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