Percutaneous nephrostomy in pyonephrosis

Abstract

A series of 76 pyonephrotic kidneys in 73 patients were drained by percutaneous nephrostomy (PN) tube and examined to evaluate the contribution of this technique to the treatment of pyonephrosis. In 71 patients, clinical symptoms disappeared 24-48 h after the procedure. Two patients died from sepsis subsequent to anuria and underlying malignancy. Once the acute phase had remitted, interventional procedures were carried out in 39 cases, and constituted the definitive therapy in 36. In 32 cases, elective surgery was the definitive therapy, including the 3 cases not resolved after interventional procedures. Three patients in whom the obstruction cleared spontaneously following PN needed no additional treatment. Major complications included 6 cases of sepsis, all of which resolved satisfactorily with proper medical therapy.

Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases

“…The co-existence of azotemia and pyonephrosis increases the urgency as well as value of percutaneous Nephrostomy. Camunez et al also observed that following PCN in pyonephrosis clinical symptoms disappeared in 24 -48 h after the procedure and once the acute phase was over definitive surgery could be carried out (9).…”

A Comparative Study of Percutaneous Nephrostomy Versus Dj Stenting in Infective Hydronephrosis in Calculous Disease

“…(7) Likewise St.Lezin et al salvaged 78.3% of 23 pyonephrotic kidneys drained percutaneously. (8) In fact, percutaneous nephrostomy was shown to decrease mortality associated with gram-negative sepsis due to obstruction of the urinary tract (7.4% mortality) compared to treatment with antibiotics and steroids alone (40%) or surgical decompression. (9) The development of internal ureteral stents that could be placed cystoscopically provided an alternative to percutaneous renal drainage in cases of ureteral obstruction.…”

“…(11) Improvements in stent design resulted in greater ease of placement and more secure positioning. (12,13,14) However, despite these improvements, the use of ureteral stents for drainage of infected, obstructed kidneys was sporadic and reports in the literature were few (8,15) . Indeed, in 1 series of 23 patients with pyonephrosis treated with percutaneous nephrostomy a previous retrograde attempt at drainage had failed in 30%.…”

“…Indeed, in 1 series of 23 patients with pyonephrosis treated with percutaneous nephrostomy a previous retrograde attempt at drainage had failed in 30%. (8) Proponents of percutaneous drainage of the obstructed, infected collecting system cite several advantages over retrograde ureteral stent placement. They argue that the external tube provides means for monitoring on-going drainage of the kidney.…”

“…Percutaneous nephrostomy avoids manipulation of the obstructed ureter with its potential for perforation and exacerbation of the infection. (8,16) Finally, advocates of nephrostomy drainage maintain that the procedure can be performed with patient under local anesthesia, obviating the need for an anesthesiologist or risk of general anesthesia in patients with hemodynamic instability.…”