Pyonephrosis: diagnosis and treatment: report of 65 cases

Abstract

Pyonephrosis is one of the most severe pathologies caused by high urinary tract obstruction, which untreated may progress to serious complications that culminate with septic shock and death. The most common cause of pyonephrosis is represented by kidney stones. Currently, eco-guided percutaneous nephrostomy provides a means to drain the pus from the kidney cavity and determine residual kidney function. This study has included 65 cases that were observed for a period of 5 years. Lumbar pain was present in 84%, fever, and chills are found in 46% of patients, and irritative symptoms in 75% of cases. Cytobacteriological urine analysis shows E. coli urinary tract infections in 55%, Enterococcus in 9% of cases, Klebsiella in 3% of cases, Pseudomonas and Proteus in 1.5% of cases each, and 30% of patients had sterile urine cultures. In all cases, the diagnosis was confirmed by imagistic means. The predominant etiologic factor was incriminated by urinary stones in 53 cases, followed by genital neoplasia with secondary ureteral obstruction in 6 cases. Treatment consisted of primary nephrectomy in 48% of cases, in 38% of cases nephrectomy is performed at 3 weeks after eco-guided percutaneous nephrostomy and drainage of pus, primary eco-guided percutaneous nephrostomy was applied in 4 cases with a positive result, the resumption of kidney function. In 3 cases, patients did not survive until surgery (severe urosepsis and secondary septic shock). In conclusion, nephrectomy is the surgical treatment of choice. The best treatment is to diagnose and treat urinary stones, which is the main etiologic factor.