Emphysematous pyelonephritis: Nephrectomy is still standard of treatment? 15 years ‘experience

Abstract

Emphysematous pyelonephritis (EPN) is a severe form of urinary tract infection with a high mortality unless treated rapidly and effectively. Our objective is to review our experience over 15 years (from 2005 to 2020) on conservative treatment according to clinical, bacteriological, radiological, therapeutic and evolutionary aspects of EPN. We analyzed the medical record of patients treated for EPN at the Urology service of Mohammed the VIth University Hospital of Marrakesh. There were 18 patients with an average age of 54 years. They were all diabetics. Lithiasis obstruction of the upper excretory tract was found in 15 patients (83%). The germs involved were Gram-negative bacilli, especially E. coli (61% in our series) followed by Staphylococci (22.2%), Klepsiella (11.1%), and proteus mirabilis in 5.5% of cases. Resuscitation measures, including antibiotic and insulin therapy, were introduced as a matter of urgency for patients if needed. In 77.8% of cases, treatment was conservative: 11 patients (61.1%) underwent endoscopic drainage with a JJ stents and 3 patients (16.6%) underwent open drainage of peri-renal collections with a nephrostomy tube placement). Only 4 patients (22.2%) patients underwent nephrectomy. No deaths were observed during the course.