AUA 2017: Stone Disease: Surgical Therapy VI

Boston, MA ( Urologists from University of Texas Southwestern conducted a retrospective review to evaluate the possibility of managing patients with xanthogranulomatous pyelonephritis (XGP) with percutaneous nephrolithotomy (PCNL) as a means of implementing nephron-sparring treatment. Patients with XGP are often managed with nephrectomy to mitigate the risk of systemic infection and malignancy.

Their review consisted of 11 patients that underwent PCNL and had radiographic evidence of XGP. They reported a 27% postoperative complication rate (Clavien-Dindo grade III, 3 patients) with 55% of patients affected by multiple urinary tract infections. However, 73% of patients had preservation of GFR and 92% of kidneys remained functional postoperatively. They concluded that PCNL is feasible in a select group of patients with radiographic XGP, however mandatory long-term follow-up is required.

Following the presentation several comments from the audience raised questions as to the safety and reliability of using PCNL for XGP. Importantly, XGP is regarded as a histological diagnosis after review of a surgical specimen or biopsy. Furthermore, patients with XGP are at risk for renal cell carcinoma and often require renal biopsy, which was not performed in any of the eleven patients. In addition, the stone burden of the majority of XGP patients is low and chronic infection from small calculi is a common etiology. One comment suggested that perhaps many of these patients had UPJ obstruction, with a severely hydroneprotic, infected kidney on imaging as opposed to XGP. Overall, the use of PCNL for XGP should be practiced with the utmost caution and may not be a safe treatment modality.

Presented by: Noah Canvasser, MD

Authors: Noah Canvasser, Aaron Lay, Shuvro De, Arthi Satyanarayan, Elysha Kolitz, Margaret Pearle, Jodi Antonelli
Affiliation: University of Texas Southwestern, Dallas, TX

Written By: Daniel Lama for

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA