Pyelonephritis surgery: Difference between revisions
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===Ureteroscopy=== | ===Ureteroscopy=== | ||
Flexible ureteroscopy is done for the treatment of obstructive pyelonephritis. It is very effective in removing large proximal placed ureteral stones that are greater than 1.5cm. Flexible ureteroscopy has a stone free rate of almost 80%. It has advantages over Transperitoneal laparoscopic ureterolithotomy in that:<ref name="pmid27375691">{{cite journal| author=Sahin S, Resorlu B, Eksi M, Aras B, Atar A, Tugcu V| title=Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis. | journal=Pak J Med Sci | year= 2016 | volume= 32 | issue= 3 | pages= 570-4 | pmid=27375691 | doi=10.12669/pjms.323.9938 | pmc=4928400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27375691 }} </ref> | Flexible ureteroscopy is done for the treatment of obstructive pyelonephritis. It is very effective in removing large proximal placed ureteral stones that are greater than 1.5cm. It can be performed after drainage of an infected kidney to effectively remove renal stones. Flexible ureteroscopy has a stone free rate of almost 80%. It has advantages over Transperitoneal laparoscopic ureterolithotomy in that:<ref name="pmid27375691">{{cite journal| author=Sahin S, Resorlu B, Eksi M, Aras B, Atar A, Tugcu V| title=Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis. | journal=Pak J Med Sci | year= 2016 | volume= 32 | issue= 3 | pages= 570-4 | pmid=27375691 | doi=10.12669/pjms.323.9938 | pmc=4928400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27375691 }} </ref> | ||
*It causes less post operative pain | *It causes less post operative pain | ||
*Has a lesser hospital stay | *Has a lesser hospital stay | ||
*Early return to daily routine | *Early return to daily routine | ||
===Percutaneous nephrostomy=== | ===Percutaneous nephrostomy=== | ||
Revision as of 17:40, 25 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
PMID: 8126807
Overview
Pyelonephritis is usually managed medically. In recurrent infections, additional investigations may identify an underlying abnormality like a stone, a tumour or an underlying pathological process that has to be aggressively dealt with. Occasionally, surgical intervention is necessary to improve chances of recurrence and to prevent devastating complications. Various renal conditions like obstructive pyelonephritis with presence of stones in the presence of an infected kidney can be fatal and requires urgent management.[1]
Surgery
Surgery may be necessary in case of continuous worsening of pyelonephritis, recurrent disease, renal failure or development of complications Pyelonephritis. Xanthogranulomatous Pyelonephritis is confused with renal tumour and is usually diagnosed after resection of the kidney and performing microscopic examination. The following kinds of surgeries can be associated with the management of Pyelonephritis.[1][2][3]
Biopsy
- A biopsy can be done to confirm the diagnosis of a complex renal pathology or to check the extent and type of damage to the kidney. It is used specifically in case of xanthogranulomatous pyelonephritis that is confused with renal tumours usually Wilm's tumour.
- The histopathological exam of the biopsy specimen confirm xanthogranulomatous type of pyelonephritis.
Ureteroscopy
Flexible ureteroscopy is done for the treatment of obstructive pyelonephritis. It is very effective in removing large proximal placed ureteral stones that are greater than 1.5cm. It can be performed after drainage of an infected kidney to effectively remove renal stones. Flexible ureteroscopy has a stone free rate of almost 80%. It has advantages over Transperitoneal laparoscopic ureterolithotomy in that:[4]
- It causes less post operative pain
- Has a lesser hospital stay
- Early return to daily routine
Percutaneous nephrostomy
Nephrolithotomy/Ureterolithomy
Percutaneous nephrolithotomy or transperitonial laproscopic ureterolithotomy (TLU) are effective surgical treatment options for pyelonephritis. TLU is effective in removing large ureteral stones with a very high stone free rate approaching unto 100%.[4]
Partial Nephrectomy
- A partial nephrectomy is performed in case of a localised renal pathology. It can also be done in case of low grade real disease that is resistant to medical management.
- Partial Nephrectomy involves excising only the involved segment of the kidney leaving behind the healthy part of the kidney.
Nephrectomy
- Nephrectomy is considered in case the renal involvement is diffuse or the damage to the kidney is in an advanced stage.
Vacuum Sealing Drainage
Emphysematous pyelonephritis can be treated with a Vacuum Sealing drainage.[5]
References
- ↑ 1.0 1.1 Kanno T, Matsuda A, Sakamoto H, Higashi Y, Yamada H (2013). "Safety and efficacy of ureteroscopy after obstructive pyelonephritis treatment". Int J Urol. 20 (9): 917–22. doi:10.1111/iju.12060. PMID 23347168.
- ↑ Malek RS, Elder JS (1978). "Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature". J Urol. 119 (5): 589–93. PMID 660725.
- ↑ Libre Pathology https://librepathology.org/wiki/Medical_kidney_diseases#cite_note-Ref_Sternberg5_1729-75 Accessed in Jan 24,2017
- ↑ 4.0 4.1 Sahin S, Resorlu B, Eksi M, Aras B, Atar A, Tugcu V (2016). "Flexible ureteroscopy versus laparoscopy for the treatment of patients who initially presented with obstructive pyelonephritis". Pak J Med Sci. 32 (3): 570–4. doi:10.12669/pjms.323.9938. PMC 4928400. PMID 27375691.
- ↑ Wang HD, Zhu XF, Xu X, Li GZ, Liu N, He F; et al. (2017). "Emphysematous Pyelonephritis Treated with Vacuum Sealing Drainage". Chin Med J (Engl). 130 (2): 247–248. doi:10.4103/0366-6999.198021. PMID 28091422.