MINIMALLY INVASIVE TREATMENT OF RENAL ABSCESS

Purpose: We critically evaluated the most appropriate management of re nal abscesses, and identified the set of patients that most benefits f rom conservative treatment. Materials and Methods: We retrospectively reviewed charts regarding discharge diagnoses, radiological studies, p athological specimens, epidemiology factors and outcomes. Statistical analysis was performed using loglinear and covariant analysis. Results : Nine years of experience (1984 to 1993) at 2 affiliated hospitals (1 public and 1 private) were reviewed. A total of 52 patients with rena l abscesses was identified with a followup rate of 98%. In immunocompe tent patients 100% of small abscesses (less than 3 cm.) managed by ant ibiotics and observation alone resolved. Of medium abscesses (3 to 5 c m.) treated with percutaneous abscess drainage alone 92% resolved. Lar ge abscesses (greater than 5 cm.) often required more than 1 percutane ous drainage procedure (33%) or adjunct open surgical intervention (37 %). Statistical analysis revealed that no single treatment modality yi elded a superior resolution rate or shorter hospitalization for absces ses stratified by size, patient age or treatment instituted early (198 4 to 1993) or late (1992 and 1993) in the study period. Conclusions: O ur series suggests that percutaneous drainage is as effective as open surgery for large and medium renal abscesses. Small abscesses may be e ffectively treated with a course of intravenous antibiotic therapy. A treatment algorithm is reported.