Percutaneous nephrostomy as adjunct management in advanced upper urinary tract infection

Objectives. To determine by retrospective review of 315 percutaneous nephro stomies, performed for pyonephrosis, whether this intervention has major cl inical advantages. Methods. From 1977 to 1996, under the direct supervision of the senior auth or of this report (E.K.L.), at seven hospital sites, 315 patients (181 male s, 134 females; 17 to 88 years of age) were treated with percutaneous nephr ostomy and antibiotic therapy for infected hydronephrosis. Results. Additional or disparate pathogens were identified in 116 (36.8%) o f 315 patients, leading to a clinically significant change in, or addition of, antibiotics and/or antifungal agents in 84 (73%) of 116. Most notably, we often found a clinically important disparity between the results of cult ures obtained from the nephrostomy and those obtained from bladder-urine sp ecimens. Conclusions. This retrospective review confirms previously reported advanta ges of percutaneous upper urinary tract drainage as a potentially life-savi ng adjunct in the treatment of pyonephrosis, Several case studies highlight the advantage of this maneuver in difficult cases involving obstruction du e to extensive fungus or debris. In particular, our review focuses attentio n on the clinically important insight that urine cultures from percutaneous nephrostomy drainage often identify pathogens that differ from those detec ted in concurrent bladder cultures. (C) 1999, Elsevier Science Inc.