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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. J Urol1984; 131: 203. LinkGoogle Scholar
  • 6 : Pneumaturia. JAMA1998; 31: 375. Google Scholar
  • 7 : Emphysematous pyelonephritis. J Urol1962; 87: 762. LinkGoogle Scholar
  • 8 : Emphysematous pyelonephritis: a 5-year experience with 13 patients. J Urol1985; 134: 1086. LinkGoogle Scholar
  • 9 : Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol1997; 157: 1569. LinkGoogle Scholar
  • 10 : Predictors of outcome in emphysematous pyelonephritis. J Urol1998; 159: 369. LinkGoogle Scholar
  • 11 : The effectiveness of surgery for stress incontinence in women: a systematic review. Br J Urol1996; 78: 497. Google Scholar
  • 12 : Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med2000; 160: 797. Google Scholar
  • 13 : Successful medical management of recurrent emphysematous pyelonephritis. Urology2006; 67: 623.e11. Google Scholar
  • 14 : Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis. Scand J Urol Nephrol2006; 40: 332. Google Scholar
  • 15 : Successful conservative management of emphysematous pyelonephritis, bilateral or in a solitary kidney. Scand J Urol Nephrol1997; 31: 193. Google Scholar
  • 16 : Emphysematous pyelonephritis: successful management by percutaneous drainage. J Urol1986; 136: 884. LinkGoogle Scholar
  • 17 : Treatment of emphysematous pyelonephritis with broad-spectrum antibacterials and percutaneous renal drainage: an analysis of 10 patients. J Chin Med Assoc2005; 68: 29. Google Scholar
  • 18 : Computed tomography and ultrasonography for diagnosis and treatment of renal and retroperitoneal abscesses. Urol Clin North Am1982; 9: 185. Crossref, MedlineGoogle Scholar
  • 19 : Meta-analysis: formulating, evaluating, combining, and reporting. Stat Med1999; 18: 321. 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

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