title: Emergency nephrectomy due to severe urosepsis: a retrospective, multicentre analysis of 65 cases.
abstract: OBJECTIVE
  To assess the outcome of emergency nephrectomy in a retrospective, multicentre analysis, as emergency nephrectomy due to life-threatening urosepsis is a rare clinical scenario with a high mortality, and there are few reports of clinical data on this issue.
  
  
  METHODS
  We assessed retrospectively all patients who had a nephrectomy due to life-threatening urosepsis in three referral centres in Vienna between 1994 and 2007. Patient characteristics, survival and risk factors for a fatal outcome were evaluated.
  
  
  RESULTS
  In all 65 patients (44 women and 21 men; mean age 65 years) were analysed. The mean interval from the first medical consultation to hospital admission was 4.3 days. Two-thirds of patients were admitted directly from their homes (63%), the remainder being transferred from other departments or hospitals. The most common pathological mechanism leading to urosepsis was acute pyelonephritis, often combined with nephrolithiasis. In all, 36 patients had a urological intervention before nephrectomy, i.e. percutaneous nephrostomy in 17, ureteric stent in 16 and percutaneous abscess drainage in three. Nephrectomy was performed a mean (range) of 5.7 (0-31) days after hospital admission. Thirteen patients (20%) died from septic multi-organ failure after surgery. This group was almost 20 years older than those who survived (78.6 vs 61.8 years), had a higher comorbidity rate, had undergone endourological interventions more frequently (69% vs 52%), had a longer interval to nephrectomy (6.9 vs 5.4 days), higher C-reactive protein level (294.9 vs 136.0 mg/L) and lower platelet counts (229.5 vs 307.7 million/L) at diagnosis.
  
  
  CONCLUSIONS
  Several factors were identified that influence the outcome after emergency nephrectomy for life-threatening urosepsis. Applied to the decision-making process, these risk factors could have a positive impact on establishing a timely indication for nephrectomy that might ultimately reduce the high mortality rate.
authors.affiliation: Department of Urology and Andrology, Donauspital, Vienna, Austria.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Berger
authors.forename: Sonja
authors.initials: S
authors.lastname: Wildhofen
authors.forename: Alexander
authors.initials: A
authors.lastname: Lee
authors.forename: Anton
authors.initials: A
authors.lastname: Ponholzer
authors.forename: Michael
authors.initials: M
authors.lastname: Rauchenwald
authors.forename: Othmar
authors.initials: O
authors.lastname: Zechner
authors.forename: Walter
authors.initials: W
authors.lastname: Stackl
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher