PERCUTANEOUS DRAINAGE IN THE TREATMENT OF EMPHYSEMATOUS PYELONEPHRITIS - 10-YEAR EXPERIENCE

Purpose: We investigated the effect of percutaneous drainage for the t reatment of emphysematous pyelonephritis. Materials and Methods: A ret rospective analysis was done of 25 patients with emphysematous pyelone phritis who were treated initially with computerized tomography (CT) g uided percutaneous drainage during a 10-year period. The patients were concomitantly treated with antibiotics, fluids, and correcting blood glucose and/or ureteral obstruction. We also compared our results of p ercutaneous drainage to CT findings. Results: CT identified 12 patient s with emphysematous pyelonephritis who had gas with little fluid and 13 who had gas with renal or perirenal fluid collections. In 20 of 25 patients (80%) antibiotic therapy combined with percutaneous drainage constituted the only treatment required. Three patients (12%) whose cl inical status improved after percutaneous drainage subsequently underw ent elective nephrectomy without further complications. Two patients ( 8%) died of multiple organ failure, There was no correlation between t he gas patterns of emphysematous pyelonephritis and initial success wi th the antibiotics and percutaneous drainage. There were no recurrence s and no complications during a followup of 1 to 10 years (mean 5). Me an duration of treatment was 5.54 weeks (range 1 to 12.6), Conclusions : CT is an efficient imaging method for diagnosis, guiding the drainag e procedures and monitoring response to percutaneous drainage of emphy sematous pyelonephritis. Antibiotic therapy combined with CT guided pe rcutaneous drainage of emphysematous pyelonephritis is an acceptable a lternative to antibiotic therapy with surgical intervention.