Efficacy of percutaneous nephrostomy for management of pyonephrosis

ABSTRACT

To evaluate the efficacy of Percutaneous Nephrostomy [PCN] for the management of pyonephrosis. This descriptive study of 78 cases of pyonephrosis was conducted at Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar Pakistan from July 2010 to December 2011. Ultrasound guided percutaneous nephrostomy was performed and pus was sent for culture and sensitivity. Urine output in the PCN was monitored. Patients were clinically observed. Blood chemistry was analyzed. Patients were put on antibiotics based on culture and sensitivity. Efficacy was defined as the symptomatic relief of a patient in respect to pain and fever and biochemical improvement in terms of decreased TLC count and improved RFTs in early post PCN period. Data was collected on a structured proforma and was analyzed on SPSS version 10. Out of 78 patients who underwent percutaneous nephrostomy for pyonephrosis, 42[53.84%] were male and 36[46.15%] were female. The majority, 69[88.46%] patients had underlying obstructing urinary calculi. Other causes of obstruction included, benign strictures 5[6.41%]; pelviureteric junction obstruction 3[3.84%] and malignant stricture 1[1.2%]. Culture of the drained pus was positive in 73[93.58%] patients. After 2 to 3 weeks of PCN, 53[69%] patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion whereas 23[31%] patients required major surgery after 4 to 6 weeks. Percutaneous drainage for pyonephrosis is an effective diagnostic and therapeutic method, decompressing the obstructed and infected pelvicaliceal system and rapidly stabilizes the patient's clinical condition and makes him fit for definitive treatment