Treatment of Emphysematous Pyelonephritis with Ureteric Obstruction When Percutaneous Drainage Has Not Achieved Resolution

This protocol addresses the clinical situation where emphysematous pyelonephritis (EPN) is accompanied by ureteric obstruction and a prior percutaneous drainage attempt has failed to meet its radiological endpoint.

Clinical Scenario

EPN with ureteric obstruction. Any indication of ureteric obstruction must be addressed — percutaneous nephrostomy or ureteric stenting are the first-line options unless nephrectomy is directly indicated. This protocol applies once those initial measures have been attempted and have not resolved the infection.

Why This Step Is Reached — Prior Treatment Failure

The preceding approach — percutaneous drainage, optimally performed under CT guidance using large-caliber tubes — aims for disappearance of gas and resolution of inflammation on follow-up CT, a process that may take up to 12 weeks. When that radiological target is not achieved, escalation to the next protocol is required.

Next-Step Overview — Partial

For patients with extensive renal destruction who are fit for surgery, a surgical intervention becomes the indicated approach. The specific eligibility criteria and the full decision framework for selecting the appropriate surgical form are detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

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.

Emergency nephrectomy is advised for patients with extensive renal destruction.

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