Percutaneous Drainage in the Treatment of Emphysematous Pyelonephritis: 10-Year Experience

Abstract

CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to percutaneous drainage of emphysematous pyelonephritis. Antibiotic therapy combined with CT guided percutaneous drainage of emphysematous pyelonephritis is an acceptable alternative to antibiotic therapy with surgical intervention.

194 Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up

“…The clinical presentations of EPN among the present patients were similar to those reported previously, with loin pain and fever (70%) being the predominant symptom [7,8,16]. Patients who had delayed treatment presented with septic shock, and those with a solitary kidney presented with acute renal failure.…”

“…This taboo was also rejected in recent years and a new treatment strategy of kidney preservation emerged [8][9][10][11]. The reasons for this change were the high mortality rates of emergency nephrectomy (17.6-40%) [5,6] and advances in image-guided procedures for drainage of the gas and infected fluids, using PCDs [9,10].…”

“…The reasons for this change were the high mortality rates of emergency nephrectomy (17.6-40%) [5,6] and advances in image-guided procedures for drainage of the gas and infected fluids, using PCDs [9,10]. Chen et al [8], in their experience with 25 patients, suggested that percutaneous drainage is safe and effective for EPN, and that can result in cure. Moreover, surgical intervention often poses a substantial risk for patients with haemodynamic instability.…”

“…We recommend considering this method for patients with localized disease (class I or II in the Huang classification) who have no renal obstruction. When patients have EPN in a solitary kidney or bilateral EPN, conservative treatment, and drainage if there is a poor response, should be tried before embarking on nephrectomy; this might help to obviate life-time renal dialysis [8].…”

“…Emergency nephrectomy after medical control of septicaemia and diabetes was reported [5,6]. The availability of effective antibiotics and advances in image-guided procedures resulted in the use of less aggressive surgical approaches such as percutaneous drainage [7][8][9]. Moreover, some authors suggested medical treatment alone [10].…”