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Outcome of conservative and minimally invasive management in emphysematous pyelonephritis

CONTEXT: Developing countries. INTRODUCTION: Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by acute necrotizing infection with the presence of gas in the kidney, perinephric space, and/or urinary collecting system. MATERIALS AND METHODS: It is a retrospective study of inpa...

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Autores principales: Sengupta, Soumish, Basu, Supriyo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343272/
https://www.ncbi.nlm.nih.gov/pubmed/34421265
http://dx.doi.org/10.4103/UA.UA_85_20
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author Sengupta, Soumish
Basu, Supriyo
author_facet Sengupta, Soumish
Basu, Supriyo
author_sort Sengupta, Soumish
collection PubMed
description CONTEXT: Developing countries. INTRODUCTION: Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by acute necrotizing infection with the presence of gas in the kidney, perinephric space, and/or urinary collecting system. MATERIALS AND METHODS: It is a retrospective study of inpatients at the Department of Urology, RG Kar Medical College and Hospital, Kolkata, which includes twenty patients diagnosed as EPN between September of 2018 and May of 2020. RESULTS: Patients were classified as per computed tomography (CT) severity grading proposed by Huang and Tseng. In our study, medical management with antibiotics was effective in 10% of patients. Twenty percent of patients were treated with medical management and internal ureteral stenting. Fifty percent of the patients were treated with medical management and percutaneous nephrostomy (PCN). Ten percent needed PCN drainage in addition to Double J (DJ) stenting. Ten percent needed percutaneous drainage of perinephric abscess along with PCN. Ten percent of patients were treated with open drainage in addition to DJ stenting and percutaneous drainage of perinephric collection as they failed to respond to minimally invasive intervention alone, with repeat ultrasonography showing persistent collection. There was no mortality in the group. CONCLUSION: EPN patients are mostly moribund with multiple comorbidities. It is vital to comprehend the management with a prompt CT imaging. Proactive hemodynamic stabilization, antimicrobial therapy, complementing it with DJ stenting and/or PCN in cases not responding to antibiotics alone, can treat most of the patients with this pathology.
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spelling pubmed-83432722021-08-20 Outcome of conservative and minimally invasive management in emphysematous pyelonephritis Sengupta, Soumish Basu, Supriyo Urol Ann Original Article CONTEXT: Developing countries. INTRODUCTION: Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by acute necrotizing infection with the presence of gas in the kidney, perinephric space, and/or urinary collecting system. MATERIALS AND METHODS: It is a retrospective study of inpatients at the Department of Urology, RG Kar Medical College and Hospital, Kolkata, which includes twenty patients diagnosed as EPN between September of 2018 and May of 2020. RESULTS: Patients were classified as per computed tomography (CT) severity grading proposed by Huang and Tseng. In our study, medical management with antibiotics was effective in 10% of patients. Twenty percent of patients were treated with medical management and internal ureteral stenting. Fifty percent of the patients were treated with medical management and percutaneous nephrostomy (PCN). Ten percent needed PCN drainage in addition to Double J (DJ) stenting. Ten percent needed percutaneous drainage of perinephric abscess along with PCN. Ten percent of patients were treated with open drainage in addition to DJ stenting and percutaneous drainage of perinephric collection as they failed to respond to minimally invasive intervention alone, with repeat ultrasonography showing persistent collection. There was no mortality in the group. CONCLUSION: EPN patients are mostly moribund with multiple comorbidities. It is vital to comprehend the management with a prompt CT imaging. Proactive hemodynamic stabilization, antimicrobial therapy, complementing it with DJ stenting and/or PCN in cases not responding to antibiotics alone, can treat most of the patients with this pathology. Wolters Kluwer - Medknow 2021 2021-05-28 /pmc/articles/PMC8343272/ /pubmed/34421265 http://dx.doi.org/10.4103/UA.UA_85_20 Text en Copyright: © 2021 Urology Annals https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Sengupta, Soumish
Basu, Supriyo
Outcome of conservative and minimally invasive management in emphysematous pyelonephritis
title Outcome of conservative and minimally invasive management in emphysematous pyelonephritis
title_full Outcome of conservative and minimally invasive management in emphysematous pyelonephritis
title_fullStr Outcome of conservative and minimally invasive management in emphysematous pyelonephritis
title_full_unstemmed Outcome of conservative and minimally invasive management in emphysematous pyelonephritis
title_short Outcome of conservative and minimally invasive management in emphysematous pyelonephritis
title_sort outcome of conservative and minimally invasive management in emphysematous pyelonephritis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343272/
https://www.ncbi.nlm.nih.gov/pubmed/34421265
http://dx.doi.org/10.4103/UA.UA_85_20
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