Is Percutaneous Drainage The New Gold Standard In Management Of Emphysematous Pyelonephritis? Evidence From A Systematic Review

Main Category: Urology / Nephrology
Article Date: 20 Jun 2008 - 0:00 PDT

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UroToday.com - This comprehensive meta-analysis of the literature related to the management of emphysematous pyelonephritis suggests that percutaneous nephrostomy drainage should be a part of the initial therapy for this life-threatening condition.

Using 10 studies, comprised of 210 patients with emphysematous pyelonephritis, they noted that almost all (96%) of the patients had diabetes and a third had urinary tract obstruction. CT imaging provides 100% diagnostic accuracy, and the most common organisms include E. coli (67%) and Klebsiella (20%). The mortality from medical management alone was 50%, death from medical management plus emergency nephrectomy was 25%, and medical management combined with percutaneous nephrostomy drainage resulted in 13.5% mortality.

With the high rate of urinary tract obstruction associated with this disease, it is not surprising that the mortality rate was significantly less in patients treated with percutaneous drainage compared to the other treatments. Therefore, percutaneous drainage would appear to be a part of the first-line therapy of emphysematous pyelonephritis, with nephrectomy being reserved for those patients who do not show prompt response to this therapy combined with medical management; as the mortality rate in this subgroup was 7%.

Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N'dow J.
J Urol. 2008 May;179(5):1844-9
doi:10.1016/j.juro.2008.01.019

Reported by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC

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