Efficacy of percutaneous nephrostomy for management of pyonephrosis

Abstract

Objective: To evaluate the efficacy of Percutaneous Nephrostomy (PCN) for the management of pyonephrosis.

Methodology: This descriptive study of 78 cases of pyonephrosis was conducted at Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar Pakistan from July 2010 to December 2011. Ultrasoundguided percutaneous nephrostomy was performed and pus was sent for culture and sensitivity. Urine outputin the PCN was monitored. Patients were clinically observed. Blood chemistry was analyzed. Patientswere put on antibiotics based on culture and sensitivity. Efficacy was defined as the symptomatic reliefof a patient in respect to pain and fever and biochemical improvement in terms of decreased TLC countand improved RFTs in early post PCN period. Data was collected on a structured proforma and was analyzedon SPSS version 10.

Results: Out of 78 patients who underwent percutaneous nephrostomy for pyonephrosis, 42(53.84%) weremale and 36(46.15%) were female. The majority, 69(88.46%) patients had underlying obstructing urinarycalculi. Other causes of obstruction included, benign strictures 5(6.41%); pelviureteric junction obstruction3(3.84%) and malignant stricture 1(1.2%). Culture of the drained pus was positive in 73(93.58%) patients.After 2 to 3 weeks of PCN, 53(69%) patients underwent minimally invasive procedures as definitive treatmentof the obstructing lesion whereas 23(31%) patients required major surgery after 4 to 6 weeks.

Conclusion: Percutaneous drainage for pyonephrosis is an effective diagnostic and therapeutic method,decompressing the obstructed and infected pelvicaliceal system and rapidly stabilizes the patient's clinicalcondition and makes him fit for definitive treatment.