Outcome of Percutaneous Nephrostomy for the Management of Pyonephrosis

ObjectiveThe aim of this study was to evaluate the efficacy of percutaneous nephrostomy (PCN) drainage for the interim management of pyonephrosis.MethodsNinety-two consecutive patients (29 men, 63 women; mean age, 57 years; range, 23-88) who underwent PCN for the treatment of pyonephrosis from 1996 to 1999 were evaluated retrospectively. The clinical presentation, bacteriology and patient outcomes were analyzed.ResultsThe majority (77%) of patients had underlying obstructing urinary calculi. Other causes of obstruction included strictures (9%), papillary necrosis (7%), pelvi-ureteric junction obstruction (4%) and malignant stricture (3%). The microorganisms cultured were Escherichia coli (30%), Klebsiella (19%), Proteus (8%), Pseudomonas (5%), Enterococcus (5%), and Candida spp (5%). The microorganisms were sensitive to gentamicin (79%), ceftriaxone (71%), cephalexin (54%), nitrofurantoin (40%), cotrimoxazole (35%), nalidixic acid (32%) and ampicillin (29%). Only 30% of bladder urine cultures were positive for microorganisms; the addition of PCN cultures improved this yield to 58%. The antibiotic regimen was revised according to the PCN culture whenever there was a discrepancy. After PCN, 69% of patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion. Only 14% of patients required open surgery. There was low procedure-related morbidity (14%) and low overall mortality (2%).ConclusionsPCN cultures yield important bacteriological information. The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit. (Asian J Surg 2002;25(3):215-9