Abstract
BackgroundCalculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function.MethodsThe clinical data of laparoscopic nephrolithotomy performed at Peking University People’s Hospital from May 2017 to June 2020 were analyzed retrospectively. Eight patients (2 men; 6 women) aged 27 to 65 years (average age, 45.8 years) were included. Among them, 7 patients were treated with retroperitoneal approach and 1 patient by transperitoneal approach. All patients had received more than one endoscopic lithotripsy before nephrectomy. Renal dynamic imaging and computed tomography revealed the absence of function in pyonephrosis before nephrectomy. General clinical data and perioperative data were recorded. All nephrectomies were performed by the same physician.ResultsLaparoscopic surgery was successfully performed in 7 patients; however, 1 patient underwent open surgery because of bleeding. The operation time, average operation time, and blood loss were 1.5–4.5 h, 3.4 h, and 100–1000 ml (average, 300 ml), respectively. The postoperative pathology showed inflammatory renal disease in 6 patients, xanthogranulomatous pyelonephritis in 1 patient, and high-grade urothelial cancer in 1 patient. The average postoperative hospital stay was 5.3 days. One patient had a Clavien–Dindo Grade IIIb complication (severe hematuria), which required laparotomy, and was found that there was bleeding of ureteral stump. None of the patients experienced poor healing of endoscopic wounds.ConclusionFor patients with complicated calculous pyonephrosis, renal inflammation could not be effectively controlled, and renal function was seriously damaged. Thus, kidneys should be immediately resected. With laparoscopy, patients may recover quickly, but surgeons require enough experience when performing laparoscopy to achieve safety.
Highlights
Pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost
Patients with the following characteristics were included in the study: (A) patients with history of percutaneous nephrolithotomy (PCNL) or flexible ureteroscopy lithotripsy (FURL) (≥ 1 time); (B) patients with seriously damaged renal function defined as functional phase curve of renogram showing a low-level elongated line showed at preoperative renal dynamic examination; and (C) patients with renal cortex was thinner or the renal parenchyma was severely damaged and the outflow tract of the renal pelvis and calyces was closed or narrow, with or without a long segment of ureter inflammatory thickening and with or without fistula formation showed at preoperative computed tomography (Fig. 1); (D) Internal or external drainage was performed for more than 6 weeks before nephrectomy
If adverse effects are observed in extracorporeal shock wave lithotripsy (ESWL), FURL or PCNL should be performed
Summary
Calculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function. Pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost. Liu et al BMC Surg (2020) 20:327 is often required to avoid the inflammatory damage to the whole body. The indications and timing of affected kidney resection deserve more extensive researches. More attention is needed to answer the question of how to apply the laparoscopic minimally invasive technology to complex calculous pyonephrosis resection. In the past 3 years, our center has treated 8 patients with complicated pyonephrosis caused by lithotripsy.
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