Minimally invasive treatment of renal abscess

We critically evaluated the most appropriate management of renal abscesses, and identified the set of patients that most benefits from conservative treatment.

We retrospectively reviewed charts regarding discharge diagnoses, radiological studies, pathological specimens, epidemiology factors and outcomes. Statistical analysis was performed using loglinear and covariant analysis.

Nine years of experience (1984 to 1993) at 2 affiliated hospitals (1 public and 1 private) were reviewed. A total of 52 patients with renal abscesses was identified with a followup rate of 98%. In immunocompetent patients 100% of small abscesses (less than 3 cm.) managed by antibiotics and observation alone resolved. Of medium abscesses (3 to 5 cm.) treated with percutaneous abscess drainage alone 92% resolved. Large abscesses (greater than 5 cm.) often required more than 1 percutaneous drainage procedure (33%) or adjunct open surgical intervention (37%). Statistical analysis revealed that no single treatment modality yielded a superior resolution rate or shorter hospitalization for abscesses stratified by size, patient age or treatment instituted early (1984 to 1993) or late (1992 and 1993) in the study period.

Our series suggests that percutaneous drainage is as effective as open surgery for large and medium renal abscesses. Small abscesses may be effectively treated with a course of intravenous antibiotic therapy. A treatment algorithm is reported.