Development and internal validation of a nomogram to predict perioperative complications after flexible ureteroscopy for renal stones in overnight ureteral catheterization cases



To identify risk factors by developing and internally validating a nomogram for preventing perioperative complications in overnight ureteral catheterization cases after fURS for kidney stones.


We retrospectively examined 309 patients with overnight ureteral catheterization after single fURS procedures for renal stones. fURS procedures were performed based on the fragmentation technique. The ureteral catheter was removed on postoperative day 1. Within this group, patients who experienced perioperative complications (complication group) were compared with those who did not experience complications (non-complication group). The complication group included 77 patients whose Clavien–Dindo classification score was I, II, III, or IV and/or those whose body temperature during hospitalization was over 37.5 °C.


The overall stone volume, stone-free rate, incidence of perioperative complications, and procedure duration were 1.39 mL, 94.8%, 24.9%, and 62 min, respectively. Severe complications of a Clavien–Dindo level III or IV were observed in only four cases (1.3%). Multivariate assessment revealed five independent predictors of perioperative complications after fURS with overnight catheterization: age (p = 0.11), sex (p = 0.067), stone volume (p = 0.33), Hounsfield units (p = 0.16), and narrow ureter (p = 0.018). We developed a nomogram to predict perioperative complications after fURS using these parameters.


We developed a predictive model for perioperative complications of patients with overnight catheterization after fURS for renal stones. This model could select patients who were at a low risk of complications.

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Figure 1



Area under the receiver-operating characteristic curve


Flexible ureteroscopy


Non-contrast computed tomography


Postoperative day




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This study was funded by a Grant-in-Aid for Scientific Research (C) 19K09718 (to M.J. and K.M.)

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MK: project development, data collection, and manuscript writing. KO: data collection. JA: data collection. TA: data collection. YS: data analysis. TO: project development and manuscript editing. MY: project development. JM: project development.

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Correspondence to Mitsuru Komeya.

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This study was approved by the Institutional Ethics Committee of Ohguchi East General Hospital.

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Informed consent was obtained from all individual participants included in the study.

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Komeya, M., Odaka, H., Asano, J. et al. Development and internal validation of a nomogram to predict perioperative complications after flexible ureteroscopy for renal stones in overnight ureteral catheterization cases. World J Urol 38, 2307–2312 (2020).

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  • Nomograms
  • Ureteroscopy
  • Kidney calculi
  • Perioperative care
  • Postoperative complications