Emphysematous pyelonephritis: tertiary care center experience in management and review of the literature.

INTRODUCTION: In recent years there have been changes in management modality and a lower mortality with conservative management. We analyzed the result of emphysematous pyelonephritis (EPN) management by a review of the literature. MATERIAL AND METHODS: We made a retrospective study for the period from August 2005 to July 2009. Patients were evaluated by CT and subclassified based on CT. The patients managed in different modalities and their outcomes were compared. RESULTS: A total of 28 patients were admitted with the diagnosis of EPN. The age range was 22-70 years. Five patients were managed conservatively, 17 patients underwent minimally invasive modalities (double J stent, pigtail drainage). Open drainage of the abscess was conducted in 2 patients, and 4 patients required emergency nephrectomy. Emergency nephrectomy is associated with a high mortality (75%). CONCLUSIONS: In the majority of cases, EPN was successfully treated by resuscitation and minimally invasive modalities. Percutaneous drainage should be part of the initial management strategy. This strategy is associated with a lower mortality than emergency nephrectomy.

Age, gender, and voided volume dependency of peak urinary flow rate and uroflowmetry nomogram in the Indian population.

Objectives : The objective of this study was measurement of urine flow parameters by a non invasive urodynamic test. Variation of flow rates based on voided volume, age, and gender are described. Different nomograms are available for different populations and racial differences of urethral physiology are described. Currently, there has been no study from the Indian population on uroflow parameters. So the purpose of this study was to establish normal reference ranges of maximum and average flow rates, to see the influence of age, gender, and voided volume on flow rates, and to chart these values in the form of a nomogram. Methods : We evaluated 1,011 uroflowmetry tests in different age groups in a healthy population (healthy relatives of our patients) 16-50 year old males,> 50 year old males, 5-15 year old children, and> 15 year pre-menopausal and post-menopausal females. The uroflowmetry was done using the gravitimetric method. Flow chart parameters were analyzed and statistical calculations were used for drawing uroflow nomograms. Results : Qmax values in adult males were significantly higher than in the elderly and Qmax values in young females were significantly higher than in young males. Qmax values in males increased with age until 15 years old; followed by a slow decline until reaching 50 years old followed by a rapid decline after 50 years old even after correcting voided volume. Qmax values in females increased with age until they reached age 15 followed by decline in flow rate until a pre-menopausal age followed by no significant decline in post-menopausal females. Qmax values increased with voided volume until 700 cc followed by a plateau and decline. Conclusions : Qmax values more significantly correlated with age and voided volume than Qavg. Nomograms were drawn in centile form to provide normal reference ranges. Qmax values in our population were lower than described in literature. Patients with voided volume up to 50 ml could be evaluated with a nomogram.