OBJECTIVE To explore the risk factors for postoperative urogenic sepsis (US) in the patients undergoing ureteroscopy with holmium laser lithotripsy (F-URS) and observe the activation state of Toll-like receptor 4 (TLR4)/nuclear transcription factor-κB (NF-κB) pathways.

METHODS A total of 197 patients who underwent F-URS in Ganzi People′s Hospital from Jan 2018 to Jan 2023 were recruited as the research subjects and were divided into the US group with 51 cases and the non-US group with 146 cases according to the status of US after R-URS. Multivariate logistic analysis was performed for the risk factors for the postoperative US in the F-URS patients. The values of TLR4 and NF-κB in diagnosis of postoperative US were analyzed by means of receiver operating characteristic (ROC) curves.

RESULTS The incidence of US was 25.89% after F-URS. The result of multivariate logistic regression analysis showed that the no less than 60 years of age, operation duration no less than 1 hour, history of urinary tract surgery, high level of WBC and low level of PLT were the risk factors for the postoperative US in the F-URS patients(P < 0.05). The levels of serum TLR4 and NF-κB of the US group were higher than those of the non-US group(P < 0.05). The area under curve (AUC) of the joint detection of TLR4 and NF-κB was 0.889 in diagnosis of US, with the sensitivity 80.40%, the specificity 82.20%.

CONCLUSION The incidence of postoperative US is high among the F-URS patients and is associated with the age, operation duration, history of urinary tract surgery, WBC level and PLT level. The TLR4/NF-κB signaling pathways of the F-URS patients with postoperative US are activated. The joint detection of TLR4 and NF-κB may facilitate the diagnosis of postoperative US in the F-URS patients.