[Surgical treatment of purulent gestational pyelonephritis long-term results]

For 20-year period surgery on the kidneys in purulent pyelonephritis was conducted in more than 130 pregnant women. Pyelonephritis was represented by apostematous nephritis and carbuncules with purulent parenchymal fusion. Long-term results (2 to 13 years) were studied in 75 women. Depending on the disease severity, nephrostomy or nephrectomy was performed (61 and 14 cases, respectively). Treatment results were assessed by excretory urography, ultrasound and radionuclide investigations of the kidneys, results of urine bacterial test. The treatment efficacy criterion was the absence of bacteriuria, recurrence of cystitis and acute pyelonephritis in the operated or contralateral kidney. Pathology was not detected in 30 of 55 females after nephrostomy. The rest 25 females had bacteriuria (n = 10), cystitis exacerbations (n = 4), repeated attacks of pyelonephritis (n = 11). Patients with urinary infection activity as shown on urograms and echoscopy had caliceal deformation, atonic dilation of the pelvis and ureter of the operated kidneys. These findings in combination with clinical manifestations of the disease indicate torpid course of pyelonephritis which developed after purulent renal inflammation in pregnant women. Women with a single kidney after nephrectomy had no symptoms of urinary infections, disturbed nitrogen excreting and concentration function. Recurrent pyelonephritis causing disability was observed in cases when by severity of pyoinflammatory process nephrectomy should have been made.