Original Research Paper

Management Of Emphysematous Pyelonephritis With Conservative And Minimal Invasive Drainage- A Case Series

Abstract :

INTRODUCTION: Emphysematous Pyelonephritis (EPN) is a urologic emergency with acute necrotizing infection with presence of gas in the renal or peri-renal space or in urinary collecting system.OBJECTIVES: To compare the management of EPN by A] IV Antibiotics only, B] Image guided minimal invasive drainage and IV Antibiotics, C] Open Drainage and D] Emergency Nephrectomy if any.MATERIALS AND METHODS: This is a retrospective observational study, from July 2019 to March 2022 with 24 patients of EPN admitted in IPD at our institution.RESULTS: Patients classified according to CT Severity Scale (class1, 2 3A, 3B, 4). Only 12.5% patient had been cured by only medical treatment (one of class1 and other 2 of class 2), 6 (who had stone disease with HDN) out of 24 patients were treated successfully with D J Stenting and antibiotics and another 3 patients required both D J Stenting and pigtail drainage. 50% patients were treated with Percutaneous Nephrostomy (PCN) and IV antibiotics. 3 patients among these twelve required pigtail drainage with PCN. 3 patients required open drainage. There was no mortality.CONCLUSION: It is vital to initiate proper management after a prompt CT scan. Prompt Anti microbial therapy with minimal- invasive drainage by Pigtail, PCN or D J Stenting not only avoids morbidity, but also saves the kidney.SOURCE OF FUNDING: There was no funding source allocated for the study.

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