Study On Surgical Treatment Of Obstructive Pyonephrosis

Renal abscess is a severe purulent kidney infection, kidney parenchyma was extensive damage to a large number of necrotic tissue and to form a large abscess cavity. The disease is currently still a lack of authority of comprehensive epidemiological statistics. Pyogenic infection of renal is the most likely reason, but also by kidney stones, pyelonephritis, renal tuberculosis and hydronephrosis. Pathological manifestations is severe kidney damage, kidney is filled for a large number pus. Clinical manifestations is systemic infection for symptoms of poisoning, such as the acute phase of fever, weakness,chronic low-grade fever, weight loss, anemia and kidney area pain, kidney swelling, blood tests showed elevated white blood cells. The characteristic performance is purulent urine, the naked eye and microscopy can be found. But when suffering from urinary tract obstruction, pyuria can not be discharged, there was no discovery. At this point, based on the pathological changes of renal extensive destruction, renal as pus filling, forming a huge Vomica. Ultrasound shows should be a fluid-filled cystic structure, while the capsule was no echo.OBJECTTIVE Pyonephrosis (renal empyema) is severe purulent kidney infection, and renal parenchyma was severely damaged, all or part of becoming a pus-filled "kidney capsule." The most common cause is secondary infection from obstruction of upper urinary tract stones, followed by the kidney and ureter hydronephrosis ,in addition to renal tuberculosis, pyelonephritis and other causes. The most pathogenic bacteria is the E. coli bacteria. In recent years, with the rapid development of science Endourology, broad-spectrum antibiotics widely used in the treatment of renal abscess ,the treatment of renal abscess new developments, unlimited to Phase I of renal resection. From January 2004 to January 2009, ourdepartment had treated 41 patients with renal abscess, according to the actual condition of patients with a variety of treatment programs, and patients were followed up. Summary of clinical strategy for treatment of septic kidney in different effects for the future treatment of renal abscess provide a reference.CLINICAL MATERIAL 41 cases in this group. Male 23 cases, female 18 cases . Age 29 to 72 years, mean 48.9 years. All were unilateral pyonephrosis. And the left 22 cases, the other side 19 cases. All patients have varying degrees of ipsilateral low back pain. Every patient checked the emission computerized tomographic scanner (ECT) inspection, cluing that patients to moderate renal damage in 21 cases, 12 cases of severe damage, non-functional in 8 cases. In addition to non-functional, the glomerular filtration rate (GFR) clues 5.2-34.7ml/min/1.73 m2, the average 20.8ml/min/1.73 m2. B-model ultrasound scanning found in stone, of which 23 cases of kidney and renal pelvis stones, upper ureteral stones in 10 cases, middle and lower ureter stones in 8 cases.CLINICAL TREATMENT The group of 41 patients, preoperative routine we had given anti-infection, regulating water and electrolyte balance, symptomatic support perioperative treatment. 17 cases of patients suffering from Phase I nephrectomy, including eight cases of patients prompted non-functional kidney, while 9 cases of preoperative patients with severe renal impairment, GFR 5.2-10.4ml/min/1.73 m2, the average 7.8ml/min/1.73 m2. 4 cases who were prompted elevated creatinine were from eight cases of patients suffering from non-functioning kidney, creatinine prompted 158umol/L-187umol/L.24 cases had done with renal protection therapy,which preoperative ECT prompted GFR12.1-34.7ml/min/1.73 m2, the average 25.6ml/min/1.73 m2. Of these, 16 cases had been given preoperative percutaneous nephrostomy to drainage, drainaging for 5 to 10 days, while sensitive to anti-infection treatment.8 cases had done operations for transurethral cystoscope DJ tube implantation, and the DJ-tube drainage for 7 to 14 days, while for the anti-infection treatment. In phase II we perform operations for ureteroscopic lithotripsy in 6 cases, percutaneous nephrolithotomy in 7 cases, laparoscopic or open ureterolithotomy in 7 cases, pyelolithotomy in 4 cases.FOLLOW UP The group of 41 patients, 17 patients suffering from nephrectomy (41.5%), patients were followed up for more than 1 year, lost 2 cases. 24 cases (58.5%) patients with renal protection therapy, patients were followed up more than 1 year, 3 patients lost to follow. Three cases of patients with renal abscess due to relapse, re-admitted to hospital suffering from kidney resection. 4 cases of patients with chronic pyelonephritis had been given active anti-infective treatment, review ECT prompted GFR11.9-20.5ml/min/1.73 m2, the average 16.2ml/min/1.73 m2. The remaining 14 cases suffering from renal preoperative operation prompted GFR12.1-32.9ml/min/1.73 m2, the average 24.4ml/min/1.73 m2, review GFR22.3-41.3ml/min/1.73 m2, The average 34.9ml/min/1.73 m2, compared with the previous average improving 10.5ml/min/1.73 m2.RESULTS 41 cases in this group.17 patients suffering from I-stage renal resection (41.5%), 2 cases lost to follow. 24 case with renal protection therapy, 3 cases lost to follow.And renal abscess recurrence after the treatment finally suffering from kidney removal in 3 cases, the final rate of nephrectomy is 48%. Ultimate success of the kidneys in 18 cases, of which four cases of postoperative symptoms of repeated pyelonephritis.Analysis of this group of 41 cases. Obstructive pyonephrosis after diagnosis should immediately have ECT examination for kidneys GFR. In the situation that healthy side kidney function is good, the pyonephrosis excision is the classical technique type. Under premise of guarantees the kidney, we should drainage to reduce pressure of renal pelvis as soon as possible. Expected to antibiotic therapy alone is ineffective but also dangerous.