Long-Term Antibiotic Treatment Prior to Laparoscopic Nephrectomy for Xanthogranulomatous Pyelonephritis Improves Postoperative Outcomes: Results from a Multicenter Study

Xie, Lillian; Tapiero, Shlomi; Flores, Alec R.; Armas-Phan, Manuel; Limfueco, Luke; Karani, Rajiv; Jiang, Pengbo; Cobb, Kaitlan; Sur, Roger L.; Chi, Thomas; Landman, Jaime; Kaler, Kamaljot; Clayman, Ralph V.

doi:10.1097/ju.0000000000001429

Cited by 7 publications

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“…Three studies were excluded, with all three having both unclear mean/median patient age and failure to state number of deaths [12‐14]. Finally, 40 eligible studies were identified, comprising 1139 patients with XGP from 20 nations [3,4,5,6,15–50] (Table 1). All studies were retrospective, and only five were multicentre [20,21,29,37,50].…”

Section: Resultsmentioning

confidence: 99%

“…Finally, 40 eligible studies were identified, comprising 1139 patients with XGP from 20 nations [3,4,5,6,15–50] (Table 1). All studies were retrospective, and only five were multicentre [20,21,29,37,50].…”

Section: Resultsmentioning

confidence: 99%

“…The presence or absence of XGP‐related mortality was stated by 27 studies, comprising 630 patients [4,6,15–27,29,30,32,34,35,38,40,42,43,45,49,50]. In total there were 18 deaths within 1 year of diagnosis, resulting in a weighted proportion of 1436 deaths per 100 000 patients (95% CI 292–2579; Fig.…”

Section: Resultsmentioning

confidence: 99%

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Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

et al. 2022

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To systematically review the current demographics, treatment and mortality rate associated with xanthogranulomatous pyelonephritis (XGP) and to test the hypothesis that the weighted pooled peri-operative mortality rate will be <10%. MethodsSearches were performed of the Cochrane, Embase and Medline databases and the grey literature for studies published during the period 1 January 2000 to 30 August 2021. Eligible studies reported cohorts of ≥10 predominantly adult patients with XGP and described either average patient age or mortality rate. ResultsIn total, 40 eligible studies were identified, representing 1139 patients with XGP. There were 18 deaths, with a weighted pooled peri-operative mortality rate of 1436 per 100 000 patients. The mean age was 49 years, 70% of patients were female and 28% had diabetes mellitus. The left kidney was more commonly affected (60%). Four patients had bilateral XGP, and all of whom survived. Renal or ureteric stones were present in 69% of patients, including 48% with staghorn calculi. Urine culture was positive in 59% of cases. Fistulae were present in 8%. Correct preoperative diagnosis occurred in only 45% of patients. Standard treatment continues to comprise a short cause of antibiotics and open radical (total) nephrectomy. Preoperative decompression occurred in 56% of patients. When considered at all, laparoscopic nephrectomy was performed in 34% of patients. Partial nephrectomy was conducted in 2% of patients. ConclusionsXanthogranulomatous pyelonephritis has a lower mortality rate than historically reported. A typical patient is a woman in her fifth or sixth decade of life with urolithiasis. While open radical nephrectomy remains the most common treatment method, laparoscopic, and to a lesser degree partial nephrectomy, are feasible in well selected patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

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“…Nonetheless, XGPN is mostly discovered in the late stage, for which nephrectomy is the primary surgical procedure, in accordance with multiple retrospective studies ( 8 , 9 ). Xie et al found that 28~ days of preoperative antibiotics could reduce postoperative complications prominently ( 19 ). Thus, early diagnosis and treatment are particularly crucial to protecting the renal function of children.…”

Section: Discussionmentioning

confidence: 99%

Case report: Localized xanthogranulomatous pyelonephritis in children: A case report and literature review

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BackgroundXanthogranulomatous pyelonephritis (XGPN), which is featured by inflammatory destruction of renal parenchyma and fibrosis of kidney, occurs mainly among adults, sporadically among children and rarely among infants. Recurrent urinary tract infections, kidney stone-induced obstructive nephropathy, malnutrition, abnormal lipid metabolism, hypoimmunity, lymphatic obstruction and congenital urinary abnormalities may all cause XGPN among children. Its primary treatment is radical nephrectomy.Case descriptionIn this study, we describe a rare case of XGPN in a 7-year-old boy infected with Staphylococcus aureus (S. aureus). The child presented with symptoms including recurrent fever, urine culture negative. The postoperative pathology confirmed XGPN. Besides, partial nephrectomy was performed.ConclusionXGPN, as a special type of chronic pyelonephritis, is a rare pyelonephritis requiring surgical treatment. Early diagnosis and treatment are crucial to reducing its morbidity and mortality. Although radical nephrectomy is the primary therapeutic option for patients with XGPN, partial nephrectomy surgery should be considered for focal XGPN, aiming to preserve residual renal function in children as far as possible.

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“…Xie et al . [ 20 ] demonstrated the benefits of long-term antibiotic treatment before video laparoscopic approach. In our study, only 11 (19.29%) patients were submitted to laparoscopic procedure and most patients used little time of antibiotics prior to surgical resolution (median 2 days, 25 th percentile 0 days, and 75 th percentile 7 days).…”

Section: Discussionmentioning

confidence: 99%

Xanthogranulomatous pyelonephritis: Case series – Clinical, radiologic, therapeutic, and histological aspects

et al. 2022

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Purpose: Xanthogranulomatous pyelonephritis (XGP) is a chronic and severe infection of the kidney. We aimed to review the main clinical, imaging, and histological findings and to assess predictors of surgical complications or hospitalization >10 days (no deaths reported). Materials and Methods: We retrospectively searched all patients with XGP treated at our institution from 2005 to 2019, with 57 patients enrolled. Clinical data were retrieved by a single reader, computed tomographic (CT) examinations by two radiologists, and histopathological specimens by an experienced pathologist. Results: The patients’ mean age was 44.3 ± 16.2 years and 41 (71.9%) were female. The most common symptoms were flank/lumbar pain (89.5%), fever (43.9%), and recurrent urinary tract infection (43.9%). The mean time until the presumptive diagnosis was 365.1 days and the median hospitalization period was 11 days. Blood tests showed anemia (78.9%), leukocytosis (43.6%) with left shift (21.6%). Urinalysis showed hematuria (75.6%), bacteriuria (40.9%), and leukocytes (93.2%). Urine cultures showed Escherichia coli in 14.8%, Proteus mirabilis in 7.4%, while 59.3% were negative. Of 40 patients with CT examinations, 38 (95%) presented with hydronephrosis and perinephric inflammatory changes (PIC) and 22 (55%) with Bear Paw sign. PIC was the only independent predictor at multivariate analysis for surgical complications. For prolonged hospitalization, fever and PIC were independent predictors at univariate, but only fever at multivariate analysis. Conclusions: XGP is a worrisome condition, with unclear pathophysiological mechanisms. Fever and PIC at CT examinations were predictors of poor outcomes.

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Long-Term Antibiotic Treatment Prior to Laparoscopic Nephrectomy for Xanthogranulomatous Pyelonephritis Improves Postoperative Outcomes: Results from a Multicenter Study

Cited by 7 publications

References 0 publications

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases

Case report: Localized xanthogranulomatous pyelonephritis in children: A case report and literature review

Xanthogranulomatous pyelonephritis: Case series – Clinical, radiologic, therapeutic, and histological aspects

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