Emphysematous Pyelonephritis: Disparities Observed in the Use of Percutaneous Drainage Techniques

Objectives: Emphysematous pyelonephritis (EPN) has high mortality rates reaching 50%, however later studies have reported significantly lower mortality rates ranging from 0 to 37.5%. Renal percutaneous drainage techniques have reduced the mortality and the necessity for surgery.  Nevertheless, the same studies have reported a wide diversity in the usage of percutaneous drainage (PCD) and percutaneous nephrostomy (PCN) techniques. Methods: A retrospective study of 17 patients was conducted over a 10year period, from January 2008 to December 2017. All patients had undergone abdominal computerized tomography, these were reviewed and categorized according to Huang and Tseng’s classification. Results: 13 patients (76%) were categorized as class I and II, 3 (17%) as class IIIA, and 1 (6%) as class IIIB. Five patients from the class I & II categories underwent drainage of the pelvicalyceal system, 4 by PCN and 1 by Double J Stent (DJS) insertion. All the class IIIA and IIIB patients had PCN inserted. One class IIIB patient required PCD for localized gas and fluid collection but later underwent emergency nephrectomy. There were no mortalities. Conclusion: The favourable outcome of this study is in keeping with the more recent studies. However, despite the present classifications and guidelines, wide variations are reported in the use of percutaneous drains with PCD ranging from 2.5 – 91%. The lack of precise guidelines may be a cause of these disparities in the clinical management.Keywords: emphysematous, pyelonephritis, drainage, percutaneous, nephrostomy.