Percutaneous drainage of renal and perirenal abscesses: results in 30 patients

The purpose of this study was to determine the efficacy of percutaneous drainage of renal and perirenal abscesses. Thirty-two abscesses, 10 renal and 22 renal with perirenal extension, in 30 patients (16 female, 14 male; age range, 5-83 years), were drained percutaneously. Twenty-one patients had had surgery recently and/or were immunosuppressed. Ten of the 13 postoperative patients had had surgical procedures involving the urinary tract. Size of the abscesses ranged from 10 to 650 ml, and all were drained via CT or fluoroscopic guidance. The type of drainage catheter used depended on the size of the abscess. Complications were unusual. A transient febrile episode without sequelae within the first 12 hr of catheter placement was the most common complication. All patients had their abscess catheter placed while in the hospital; 12 (40%) subsequently were followed up (2-50 days) as outpatients until their catheters were removed without complications. Percutaneous drainage alone was curative in 20 patients (67%) as determined by resolution of signs and symptoms or follow-up CT. Eight (27%) had improvement of signs and symptoms but required surgery to remove tumor (one patient) or a poorly functioning or nonfunctioning kidney (five patients), perform open pyelolithotomy (one patient), or drain a loculated abscess (one patient); all eventually were cured. Three patients (10%) with multiple medical problems died before resolution could be documented, although death was not thought to be directly related to failure of therapy. Our results indicate that percutaneous drainage alone is curative in the majority of cases of renal and perirenal abscesses. Many patients can be treated safely, in part, on an outpatient basis.