Perinephric abscesses in the neurologically impaired

Study design: Retrospective chart review. Objectives: To document the occurrence and management of large perinephric abscesses in neurologically impaired patients at high risk for this infecti ous complication. Setting: US Veterans Affairs hospital. Methods: The records, radiographs, operative findings and outcomes of all p atients who presented with perinephric abscesses evident on physical exam w ithin the last 5 years were reviewed. Results: Four patients presented with large perinephric abscesses evident o n physical examination. All had severe neurologic impairment with high sens ory levels; three had spinal cord injuries, one had advanced multiple scler osis. All had neurogenic bladders and recurrent urinary tract infections. T he diagnosis was made through a combination of history, physical examinatio n and computed tomography (CT) examination. All were found to have upper tr act obstruction. All were managed with immediate abscess drainage and three had elective nephrectomy once the infection had resolved. No patients died of their perinephric abscess. Conclusions: These four cases illustrate that although advances in antibiot ics, imaging and percutaneous management have improved the speed of diagnos is and reduced the mortality in patients with perinephric abscesses, the ne urologically impaired population continues to remain at significant risk fo r the development and the delayed diagnosis of these morbid renal infection s.