Emphysematous Pyelonephritis with Renal Calculi Treated with Percutaneous Nephrolithotomy

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) today has become the first line treatment for large renal stones. The infective complications of PCNL in patients with emphysematous pyelonephritis EPN would be higher and be responsible for the increased morbidity. We retrospectively reviewed our hospital records of patients with EPN and renal stones undergoing PCNL, and assessed the outcome especially in relation to infection. Materials & Methods: The case records of all patients with EPN and renal stones having undergone PCNL at our centre were retrospectively reviewed and analyzed. The age, gender, presenting symptoms, features of septicemia, preoperative drainage, post-operative complications and outcome were recorded. Results: During the study period, 12 patients (eight females and four males) with a mean age of years who were diagnosed to have EPN, underwent PCNL for extraction of renal calculi. All patients were initially managed conservatively; five patients underwent cystoscopy and Double J stent insertion on the affected side and seven patients underwent PCN insertion. Six weeks later, PCNL was performed (Urine culture was negative) undercover of appropriate antibiotics and general anaesthesia. Nine patients had Class II; two patients had class IIIb and one patient had class IV complications as classified by Clavien-Dindo. All patients recovered well and post-operative x-rays showed clearance of stone in all. Conclusions: Percutaneous nephrolithotomy is a safe, viable option in patients with emphysematous pyelonephritis and renal calculi follows a period of conservative treatment and effective drainage of the pelvicalyceal system by either a ureteric stent or percutaneous nephrostomy. The calculi can be effectively managed with endoscopic measures with renal preservation and a good functional outcome.