WOFAPS 2025 8th World Congress of Pediatric Surgery

Demet YETIMOGLU AYDOGAN, Serpil Sancar, Meryem Anayurt, Sabriye Dayı

Bursa City Hospital, Department of Pediatric Surgery

Objective : The aim of this study is to retrospectively evaluate preoperative urinalysis (UA) parameters in pediatric patients who underwent surgical treatment for appendicitis, and to determine the diagnostic value of these parameters in distinguishing between acute and complicated appendicitis. Additionally, the study aims to highlight the importance of UA findings in the differential diagnosis, particularly in distinguishing appendicitis from urinary tract infections (UTIs).

Materials and Methods : The medical records of 776 pediatric patients who underwent appendectomy in our clinic between August 2019 and January 2025 were retrospectively reviewed. A total of 374 patients who had documented preoperative urinalysis results and histopathologically confirmed appendicitis were included in the study. Patients were classified into two groups—“acute appendicitis” and “complicated appendicitis” (defined as perforation, gangrene, or abscess)—based on intraoperative findings and postoperative pathology reports. The groups were compared in terms of demographic characteristics and urinalysis parameters. Statistical analysis included the Shapiro-Wilk test for normality, and comparisons between groups were made using the independent-samples t-test and chi-square test.

Results : Among the 374 patients included, 231 (62%) were male and 143 (38%) were female, with a mean age of 11.52 ± 3.62 years. Acute appendicitis was detected in 70% of the patients, and complicated appendicitis in 30%. Statistically significant differences were observed in urine pH (p=0.026), protein (p<0.001), ketone (p=0.031), and urobilinogen (p=0.002) levels in the complicated appendicitis group. Overall, leukocytes were present in the urine of 70% of patients, while marked leukocyturia (>5 cells/HPF) was observed in 18%. No statistically significant difference in leukocyturia was found between the acute and complicated appendicitis groups (p>0.05). Similarly, erythrocytes were detected in the urine of 72% of patients, with marked hematuria (>5 cells/HPF) present in 21%, again without significant intergroup differences. No other urinalysis parameters showed significant differences between the groups.

Conclusion : Although urinalysis alone is not sufficient for the diagnosis of pediatric appendicitis, certain specific parameters—particularly in complicated cases—may contribute to clinical decision-making. However, the presence of leukocytes in urinalysis is often interpreted as suggestive of UTI, which may lead to misdiagnosis or delay in recognizing appendicitis. Therefore, urinalysis findings in the preoperative period should not be considered solely indicative of UTI, but rather assessed as part of a comprehensive clinical evaluation that includes the possibility of appendicitis