INTRODUCTION: Renal abscess often raises therapeutic problems. Based on their experience and a review of the literature, the authors propose a treatment plant for renal abscess. MATERIAL AND METHODS: The authors report 50 cases of renal abscess treated between January 1988 and September 1999 in the Department of Urology of Charles Nicolle Hospital in Tunis. The diameter of the abscess was less than or equal to 4 cm in 19 cases, between 4 and 10 cm in 29 cases and greater than 10 cm in 2 cases. Renal ultrasound and intravenous urography are an integral part of the initial morphological assessment. All patients were treated by intravenous antibiotics for a mean duration of 28 days. Complementary percutaneous drainage of the abscess was indicated in 25 patients. Surgical treatment was indicated in 13 patients in the presence of a large perirenal collection or severe sepsis, or following failure of percutaneous drainage. RESULTS: Antibiotics alone were proposed in only 17 patients with an abscess less than 4 cm in diameter and 90% of these patients were cured. Percutaneous treatment was performed in 25 patients with an 80% success rate; the other patients underwent open surgery. One patient died after surgery in a context of septic shock despite salvage nephrectomy. The other patients has a favourable outcome. CONCLUSION: The treatment of renal abscess is based on antibiotics alone or combined with a percutaneous or surgical drainage procedure depending on the size of the abscess and the clinical course. The authors describe their decisional flow-chart.
INTRODUCTION:Renal abscess often raises therapeutic problems. Based on their experience and a review of the literature, the authors propose a treatment plant for renal abscess. MATERIAL AND METHODS: The authors report 50 cases of renal abscess treated between January 1988 and September 1999 in the Department of Urology of Charles Nicolle Hospital in Tunis. The diameter of the abscess was less than or equal to 4 cm in 19 cases, between 4 and 10 cm in 29 cases and greater than 10 cm in 2 cases. Renal ultrasound and intravenous urography are an integral part of the initial morphological assessment. All patients were treated by intravenous antibiotics for a mean duration of 28 days. Complementary percutaneous drainage of the abscess was indicated in 25 patients. Surgical treatment was indicated in 13 patients in the presence of a large perirenal collection or severe sepsis, or following failure of percutaneous drainage. RESULTS: Antibiotics alone were proposed in only 17 patients with an abscess less than 4 cm in diameter and 90% of these patients were cured. Percutaneous treatment was performed in 25 patients with an 80% success rate; the other patients underwent open surgery. One patient died after surgery in a context of septic shock despite salvage nephrectomy. The other patients has a favourable outcome. CONCLUSION: The treatment of renal abscess is based on antibiotics alone or combined with a percutaneous or surgical drainage procedure depending on the size of the abscess and the clinical course. The authors describe their decisional flow-chart.
Authors: Taylor A Sohn; Charles J Yeo; John L Cameron; Jeffrey F Geschwind; Sally E Mitchell; Anthony C Venbrux; Keith D Lillemoe Journal: J Gastrointest Surg Date: 2003-02 Impact factor: 3.452