What is the best drainage method for a perinephric abscess?

Abstract

Purpose:To compare the results of percutaneous and open drainage for perinephric abscess. Materials and Methods:The files of 86 patients who underwent drainage for perinephric abscesses from April 2001 through March 2008 were evaluated. The method of drainage for each patient was performed according to the clinical decision of the treating physician. Percutaneous tube drain (PCD) was used for drainage of the abscess in 43 patients (group 1), while the other 43 patients were managed with open drainage (group 2). Cure was defined as complete obliteration of the abscess cavity. The cure rates, complications, and hospital stay were compared between both groups. Results: The study included 50 males and 36 females with mean age 44.2 ± 17.3. The most common predisposing factors were diabetes mellitus and/or stones. Open drainage of perinephric abscesses resulted in a statistically significant higher cure rate (98% versus 69%, p < 0.001) and shorter hospital stay than PCD (3.6 versus 6 days, p < 0.001). Failure of complete drainage of multilocular abscess was observed in 8 of 13 cases (61.5%) in group 1 and one of 38 cases (2.6%) in group 2 (P < 0.001). Complications were observed in 7% of group 1 and 11.5% in group 2 (P = 0.45). After mean follow-up of 19 months, 9 of 46 patients (19.6%) had recurrence; 7 of them were in group 1. Conclusion: Percutaneous drainage of perinephric abscess is an effective minimally invasive treatment. However, PCD is not the optimal method for drainage of multilocular abscess because open surgical drainage provided higher cure rates and shorter hospitalization than PCD.

Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study

“…Consistent with previous studies, lithiasis (48.0%) and diabetes mellitus (33.7%) remained the pre dominant risk factors in the present study [3,8,9,12,16,22] . Diabetes mellitus accounts for 33.3%62.5% of all PNAs [2,7,23] 43.5%47% of RAs [7,16,17] and 28%50%…”

“…Two (2.0%) polymicrobial cases were found in the present study. There has been an increasing incidence of abscesses caused by fungi, especially Candida, particularly in immunosuppressed patients [7,12,18] , and similar cases were observed in this study.…”

“…PNA represents an extensive infection in the perinephric space [2] . It is reported that approximately 30% of PNAs come from hematogenous dissemination [2] , whereas in most cases, they result from rupture of RA [12,14] . Previous data show that > 80% of PNAs occur secondary to renal tract calculi with ascending UTIs [15] .…”

Invasive Group B streptococcus: multiloculated perinephric abscesses treated with percutaneous drainage

“…In one study comprising of 65 patients, medical treatment alone was performed in only 9% and associated mortality rate reached 33% [26]. Multiple and multiloculated abscesses should undergo open surgical drainage [27]. However, successful percutaneous and laparoscopic-assisted drainage in multiloculated abscesses have been reported [11,12].…”

Abstracts

“…Management of perinephric abscess ranges from medical treatment to intervention treatment for large collection or patient with clinical impairment (7) . Among the methods of drainage, percutaneous drainage of perinephric abscess is an effective minimally invasive treatment while open surgical drainage is preferable for multilocular abscess as it provides higher cure rates and shorter hospitalization as compared to percutaneous drainage (8) . With this patient, a midline laparotomy was more beneficial as it provided the greatest abdominal exposure of most of the retroperitoneal organs as compared to a loin incision (9).…”