This protocol addresses emphysematous pyelonephritis occurring in the specific context of ureteric obstruction. The presence of obstruction is a defining feature that shapes the management approach.
Any indication of ureteric obstruction must be addressed as part of the overall strategy — the choice of method depends on clinical circumstances, including whether nephrectomy is indicated.
Where localized gas is identified with still-functioning kidney tissue, percutaneous drainage is a central intervention in the protocol. The approach and the specifications for how it is carried out — including the guidance modality and technical requirements for the procedure — are detailed in the full regimen.
Clinical success is assessed radiologically: a follow-up CT scan demonstrating disappearance of the gas and resolution of inflammation. Reaching this endpoint may take up to 12 weeks.
DOI: 10.1038/nrurol.2009.51
Any indication of a ureteric obstruction must be managed by percutaneous nephrostomy or a ureteric stent, unless nephrectomy is indicated.
Ureteric obstruction, if present, is relieved by a percutaneous nephrostomy or stent.
Percutaneous drainage should be performed on patients who have localized areas of gas where there is still functioning kidney tissue.
The procedure is optimally performed under CT guidance.
The tubes used should be of good caliber (at least 14 Fr); with this size of tube, irrigation is not necessary.
The drainage tubes should stay in place until a follow-up CT scan shows disappearance of the gas and resolution of inflammation, which might take up to 12 weeks.
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