Is JJ Ureteral Stenting Inferior to Percutaneous Nephrostomy as a Drainage Method in Emphysematous Pyelonephritis?

Abstract

<b><i>Introduction:</i></b> The aim of the study was to examine the efficacy of JJ stenting in comparison with percutaneous nephrostomy (PCN) as a drainage method in patients with emphysematous pyelonephritis (EPN). <b><i>Methods:</i></b> We retrospectively identified patients with EPN between January 2000 and January 2021. Platelet-to-leukocytic ratio (PLR) at the time of hospital admission and discharge, time taken to clear air locules and to normalize leukocytic count, and air locule volume in mm<sup>3</sup> were identified. Renal drainage by either PCN or JJ stent was required if symptoms persist for ≥3 days or in obstructed renal units. Failure of drainage method was defined as conversion to another method of drainage, need for intensive care unit admission, salvage nephrectomy, and mortality. <b><i>Results:</i></b> Twenty-nine patients were managed by JJ stent. Treatment success was identified in 20 patients and 19 patients who were managed by PCN and JJ stent, respectively. Higher air locule volume ≥16.7 mm<sup>3</sup> and lower PLR ≤18.4 increased the risk of drainage failure (<i>p</i> = 0.009 and 0.001, respectively). <b><i>Conclusion:</i></b> Ureteral JJ stenting is an effective method for EPN drainage with a comparable overall success to the PCN use. Higher air locule volume and lower PLR increased the risk of drainage failure.

Diagnostic performance of pre-management computed tomography findings as a predictor of conservative treatment success in patients with emphysematous pyelonephritis

“…In a previous study, Elbaset et al [16] documented that higher air locules volume may be associated with different drainage methods failure (either PCD or ureteral stent) and poor clinical outcome [16]. In our The presence of hydronephrosis and urinary stasis provide the time and opportunity for bacteria to adhere to the urinary tract epithelium, multiply, and infect the host [16].…”

“…In a previous study, Elbaset et al [16] documented that higher air locules volume may be associated with different drainage methods failure (either PCD or ureteral stent) and poor clinical outcome [16]. In our The presence of hydronephrosis and urinary stasis provide the time and opportunity for bacteria to adhere to the urinary tract epithelium, multiply, and infect the host [16]. The presence of hydronephrosis increase the risk of gas chamber theory by increased the pelvicalyceal system pressure and compromised renal circulation with impaired gas transportation [6].…”

“…But, unfortunately, the term mild or sever is not clear. EPN staging is rarely correlated significantly with treatment success or failure [9][10][11][12][13][14][15][16] Consequently, as a gas-forming disease, air locules volume may play a role in predicting the disease severity and clinical outcome. Elbaset et al [9] documented that increased air locules volume upsurge the risk of drainage failure of EPN.…”

Report on the diagnosis and treatment of 3 cases of emphysematous pyelonephritis with two different outcomes

“…Leukocyte and platelets play an active role in the systemic inflammatory response to infection and antimicrobial host defense. Platelets support leucocytes in pathogen arrest and transmigration ( 18 ). Elbaset et al ( 19 ) found that lower platelet to leucocytic count ratio (PLR) is an independent simple predictor for sepsis and mortality in EPN patients.…”

“…The high glucose content in tissues provides a favorable environment for the gas-producing fermentation of bacteria, thus promoting the growth of bacteria, leading to renal parenchyma destruction and higher morbidity ( 1 , 8 ). Also, the high glucose content in tissues impairs leukocytic function and leads to higher incidence of sepsis ( 18 ). In our study, all cases were comorbid with diabetes mellitus, and had poor glycemic control at admission.…”