title: Outcome of percutaneous nephrostomy for the management of pyonephrosis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of percutaneous nephrostomy (PCN) drainage for the interim management of pyonephrosis.
  
  
  METHODS
  Ninety-two consecutive patients [29 men, 63 women; mean age, 57 years; range, 23 to 88] who underwent PCN for the treatment of pyonephrosis from 1996 to 1999 were evaluated retrospectively. The clinical presentation, bacteriology and patient outcomes were analyzed.
  
  
  RESULTS
  The majority [77%] of patients had underlying obstructing urinary calculi. Other causes of obstruction included strictures [9%], papillary necrosis [7%], pelvi-ureteric junction obstruction [4%] and malignant stricture [3%]. The microorganisms cultured were Escherichia coli [30%], Klebsiella [19%], Proteus [8%], Pseudomonas [5%], Enterococcus [5%], and Candida spp [5%]. The microorganisms were sensitive to gentamicin [79%], ceftriaxone [71%], cephalexin [54%], nitrofurantoin [40%], cotrimoxazole [35%], nalidixic acid [32%] and ampicillin [29%]. Only 30% of bladder urine cultures were positive for microorganisms; the addition of PCN cultures improved this yield to 58%. The antibiotic regimen was revised according to the PCN culture whenever there was a discrepancy. After PCN, 69% of patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion. Only 14% of patients required open surgery. There was low procedure-related morbidity [14%] and low overall mortality [2%].
  
  
  CONCLUSIONS
  PCN cultures yield important bacteriological information. The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit.
authors.affiliation: Department of Urology, Singapore General Hospital, Singapore. chee_kwan_ng@ttsh.com.sg
authors.forename: C K
authors.initials: CK
authors.lastname: Ng
authors.forename: S K H
authors.initials: SK
authors.lastname: Yip
authors.forename: L S J
authors.initials: LS
authors.lastname: Sim
authors.forename: B H
authors.initials: BH
authors.lastname: Tan
authors.forename: M Y C
authors.initials: MY
authors.lastname: Wong
authors.forename: B S
authors.initials: BS
authors.lastname: Tan
authors.forename: A
authors.initials: A
authors.lastname: Htoo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009399:Nephrons / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011704:Pyelonephritis / Q000601:surgery*; D012189:Retrospective Studies