Presented Monday, 03 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Emphysematous Pyelonephritis is an acute necrotizing parenchymal and peri renal infection with forma- tion of gas in the collecting system, renal parenchyma or peri renal tissues. Clinical course can be severe and life threatening if not recognized and treated promptly.

Materials & Methods: Twenty-two cases between yr 2002 to2006 were taken into the study. Mean age was 48 yrs, 95% were having diabetes mellitus and flank pain and fever were the most common mode of presentation. Biochemical and radiological evaluation was done in all patients. 12 patients had renal failure and E.Coli was the most common organism grown in urine culture. NCCT abdomen was done to stage the patient and plan the further management.

Results: All patients were initially managed with broad spectrum antibiotics, control of blood sugars and other supportive treatment. Out of 22 patients 3 cases were managed with only antibiotics, 2 cases with DJ stenting, ultrasound guided PCN was done in 12 cases, open incision and drainage in 5 cases and nephrectomy in 12 cases. Mean duration of hospital stay was 2 to 4 weeks and mortality occurred in 2(10%) cases.

Conclusions: Emphysematous pyelonephritis should be strongly suspected in patients with flank pain and fever who have history of diabetes mellitus and stone disease. After the advent of powerful antibiotic therapy, good monitoring techniques (CT-scan) and percutaneous drainage procedures, the mortality and renal loss has come down.

Authors: Murthy PVLN, Srikanth J, Ramreddy C, Devraj R, Suresh B, Prasad N, Kumar H

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