Pyonephrosis surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Harsh Vardhan Chawla, M.B.B.S.[2]
Surgery
- Prior to the 1980s, nephrectomy was the standard treatment for pyonephrosis.[1]
- Presently, interventional procedures are required to drain the pus in pyonephrosis.
- Drainage of the pus can be done through either retrograde decompression (placing a catheter in the ureter) or antegrade decompression through percutaneous nephrostomy tube placement.
- Retrograde decompression is a minimally invasive procedure that requires placement of catheter in ureters. It is performed under general anesthesia and is contraindicated in hemodynamically unstable patients. Ureteric stenting is a good option for drainage of pus.[2] A disadvantage of retrograde stenting is that if a stone of >2 cm is present chances of iatrogenic complications increase and therefore, this approach is avoided in such cases.[3]
- Percutaneous nephrostomy catheter placement (antegrade decompression) is done when the patient is hemodynamically unstable or retrograde decompression is not possible. The nephrostomy catheter is left indwelling for at least 24 hours. The advantages of this approach include direct access to the collecting system to administer medications, drainage of infected material, percutaneous chemolysis of stones.[4][5]
References
- ↑ Fatima R, Jha R, Muthukrishnan J, Gude D, Nath V, Shekhar S; et al. (2013). "Emphysematous pyelonephritis: A single center study". Indian J Nephrol. 23 (2): 119–24. doi:10.4103/0971-4065.109418. PMC 3658289. PMID 23716918.
- ↑ Chang CW, Huang CN (2020). "Pyonephrosis drained by double-J catheter". Clin Case Rep. 8 (12): 3586–3587. doi:10.1002/ccr3.3204. PMC 7752604 Check
|pmc=value (help). PMID 33363990 Check|pmid=value (help). - ↑ ElSheemy MS, Shouman AM, Shoukry AI, ElShenoufy A, Aboulela W, Daw K; et al. (2015). "Ureteric stents vs percutaneous nephrostomy for initial urinary drainage in children with obstructive anuria and acute renal failure due to ureteric calculi: a prospective, randomised study". BJU Int. 115 (3): 473–9. doi:10.1111/bju.12768. PMID 24698195.
- ↑ Camúñez F, Echenagusia A, Prieto ML, Salom P, Herranz F, Hernández C (1989). "Percutaneous nephrostomy in pyonephrosis". Urol Radiol. 11 (2): 77–81. doi:10.1007/BF02926481. PMID 2667249.
- ↑ Regalado SP (2006). "Emergency percutaneous nephrostomy". Semin Intervent Radiol. 23 (3): 287–94. doi:10.1055/s-2006-948768. PMC 3036372. PMID 21326775.