[Percutaneous drainage of complicated infections of the upper urinary tract]

Acute pyelonephritis associated with obstruction may result in urosepsis and septic shock. Besides the administration of antimicrobial agents, quick removal of the obstruction is the essential part of the therapeutic regimen. In 43 patients with urosepsis the obstruction which was mainly due to urinary calculi was removed by percutaneous nephrostomy. Nephrostomy drainage was the only therapeutic measure required in all but 3 patients in whom nephrectomy had to be performed. 1 patient died after nephrectomy; no death occurred after percutaneous nephrostomy. Once diuresis has started after drainage, the patient will improve. If the kidney does not produce urine immediately after drainage the decision has to be made as soon as possible whether nephrectomy has to be performed for survival or whether it is justified to wait. Perfusion studies with radioisotopes have proven to be very helpful in such decisions. If there is no perfusion, immediate nephrectomy is mandatory; however, if perfusion can be demonstrated, recovery of the kidney can be expected. 21 patients with pyonephrosis were drained percutaneously. In 2 patients the infection could be controlled by nephrectomy only. The rate of secondary nephrectomy because of a non-functioning kidney was 50%. Percutaneous drainage has proven to be very effective in 6 patients with infected renal cysts, 7 patients with intrarenal abscesses and 4 patients with perinephric abscesses. There was only 1 patient presenting with intrarenal abscess in whom percutaneous drainage was insufficient and surgical intervention became necessary.