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Emphysematous pyelonephritis treatment strategies in correlation to the CT classification: have the current experience and prognosis changed?

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Abstract

Purpose

In view of the differences in early and late management experiences based on Huang and Tseng CT classification of emphysematous pyelonephritis (EP), our study included 34 patients aimed to re-correlate the current management plans with CT classification.

Methods

A retrospective review from January 2009 to December 2018, in patients with primary or final diagnosis of EP. Data included; patients’ demographics, routine laboratory and imaging work-up. CT was performed for all, and images were classified based on Huang and Tseng classification. The CT classification was correlated to the laboratory parameters and the final treatment plans. Data were collected and analyzed using SPSS®.

Results

Complete data for 34 patients were analyzed. The majority (70%) had positive urine culture, and Carbapenems and Ureidopenicillin were the most commonly used antibiotics. Based on CT classification, 75% (26/34) of the patients were in class I and II, 6 cases with class IIIa, and only two with class IIIb, with no cases of class IV. All patients in class I and II responded well to the medical therapy, and eight required PCN/DJ. Four required nephrectomy in class III, with zero mortality.

Conclusion

Patients in class I and II comprise the majority of EP patients, and respond well to medical treatment with excellent outcome. Insertion of PCN and DJ are not required routinely, but with urinary obstruction requiring drainage, and a few cases who required nephrectomy–all with class III. Our data show improvement in the overall survival in patients for EP.

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Authors and Affiliations

  1. Urology Department, Sohar Hospital, Sohar, Oman

    Mohamed Mohamed Elawdy & Samer El-Halwagy

  2. Urology and Nephrology Center, Mansoura, Egypt

    Yasser Osman & Rasha T. Abouelkheir

  3. Saqr Hospital, Ras Al-Khaimah, United Arab Emirates

    Bassam Awad

  4. Mefrek Hospital, Abu Dhabi, United Arab Emirates

    Mohsen El-Mekresh

Authors
  1. Mohamed Mohamed Elawdy
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  2. Yasser Osman
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  3. Rasha T. Abouelkheir
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  4. Samer El-Halwagy
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  5. Bassam Awad
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  6. Mohsen El-Mekresh
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Correspondence to Mohamed Mohamed Elawdy.

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Elawdy, M.M., Osman, Y., Abouelkheir, R.T. et al. Emphysematous pyelonephritis treatment strategies in correlation to the CT classification: have the current experience and prognosis changed?. Int Urol Nephrol 51, 1709–1713 (2019). https://doi.org/10.1007/s11255-019-02220-3

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  • DOI: https://doi.org/10.1007/s11255-019-02220-3

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