Is Percutaneous Drainage the New Gold Standard in the Management of Emphysematous Pyelonephritis? Evidence From a Systematic Review

No AccessJournal of UrologyAdult Urology1 May 2008Is Percutaneous Drainage the New Gold Standard in the Management of Emphysematous Pyelonephritis? Evidence From a Systematic Reviewis accompanied byComparison of a Novel Radially Dilating Balloon Ureteral Access Sheath to a Conventional Sheath in the Porcine Model Bhaskar K. Somani, Ghulam Nabi, Peter Thorpe, Jeff Hussey, Jonathan Cook, James N’Dow, and ABACUS Research Group Bhaskar K. SomaniBhaskar K. Somani More articles by this author , Ghulam NabiGhulam Nabi More articles by this author , Peter ThorpePeter Thorpe More articles by this author , Jeff HusseyJeff Hussey More articles by this author , Jonathan CookJonathan Cook More articles by this author , James N’DowJames N’Dow More articles by this author , and ABACUS Research Group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.01.019AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: There is no current consensus on what constitutes the ideal management of emphysematous pyelonephritis. We review the current management strategies including the role of nephron preserving percutaneous drainage in the treatment of emphysematous pyelonephritis. Materials and Methods: We searched MEDLINE®, PubMed®, EMBASE®, CINAHL® and the Cochrane Library from 1966 to 2006. Abstracts were reviewed including all types of studies from prospective randomized controlled studies to small retrospective series. All relevant English language articles reporting on at least 5 patients were reviewed. Results: Ten retrospective studies on 210 patients with emphysematous pyelonephritis met the inclusion criteria. There were 167 females and 43 males with a mean age of 57 years (range 24 to 83). Of the patients 96% had diabetes mellitus and 29% had urinary tract obstruction. The diagnostic accuracy of computerized tomography was 100%. Escherichia coli and Klebsiella were the most common causative agents. The mortality from medical management alone was 50%, medical management combined with emergency nephrectomy was 25% and medical management combined with percutaneous drainage was 13.5%. Mortality was significantly less in patients undergoing percutaneous drainage compared to other treatments (Pearson chi-square p <0.001). Of the patients who underwent medical treatment with percutaneous drainage a small number (15) underwent elective nephrectomy and mortality was 6.6% (1 of 15). Conclusions: Percutaneous drainage should be part of the initial management strategy for emphysematous pyelonephritis. This strategy is associated with a lower mortality than medical management or emergency nephrectomy. Delayed elective nephrectomy may be required in some patients. References 1 : Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology1996; 198: 433. Google Scholar 2 : Emphysematous pyelonephritis: a 15-year experience with 20 cases. Urology1997; 49: 343. Google Scholar 3 : Imaging features and guided drainage in emphysematous pyelonephritis: a study of 11 cases. Clin Radiol2004; 59: 192. Google Scholar 4 : Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect2001; 34: 125. Google Scholar 5 : Emphysematous pyelonephritis. 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Google Scholar 20 : Severe emphysematous pyelonephritis in diabetic patients: diagnosis and aspects of surgical management. Urol Int2005; 75: 123. Google Scholar University of Aberdeen, Aberdeen, Scotland, United Kingdom© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsRelated articlesJournal of Urology19 Mar 2008Comparison of a Novel Radially Dilating Balloon Ureteral Access Sheath to a Conventional Sheath in the Porcine Model Volume 179Issue 5May 2008Page: 1844-1849 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsdrainagepyelonephritisinfectionsurgerykidneyMetricsAuthor Information Bhaskar K. Somani More articles by this author Ghulam Nabi More articles by this author Peter Thorpe More articles by this author Jeff Hussey More articles by this author Jonathan Cook More articles by this author James N’Dow More articles by this author ABACUS Research Group More articles by this author Expand All Advertisement PDF downloadLoading ...