Xanthogranulomatous pyelonephritis: presentation and management in the era of laparoscopy.
OBJECTIVE
To report a contemporary series of patients with xanthogranulomatous pyelonephritis (XGP, an inflammatory condition of the kidney that has traditionally been treated with open nephrectomy, ON), managed with either ON or laparoscopic nephrectomy (LN), as early reports suggest that the benefits of LN do not extend to patients with XGP.


METHODS
The medical and procedural records of patients with pathologically confirmed XGP between December 1993 to February 2004 were reviewed retrospectively. During this period, 26 patients (mean age 43.5 years, range 17-85) had surgical management of XGP; information on the mode of presentation, surgical management, hospital course and complications were analysed.


RESULTS
Twelve (46%) and 14 (54%) patients had ON and LN, respectively. The LN group had significantly lower blood loss (P = 0.002), transfusion rates (P = 0.02), time to resumption of oral intake (P = 0.002) and length of hospital stay (P = 0.002) than the ON group. One (7%) LN was converted to ON due to failure to progress. The overall complication rates between the ON and LN groups were not significantly different (P = 0.95).


CONCLUSIONS
LN in the setting of XGP is often difficult and requires advanced laparoscopic skills. In highly selected patients this approach can be offered, with acceptable morbidity, allowing for lower blood loss and shorter convalesce times.
Guzzo
Thomas J
TJ
Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. tguzzo1@jhmi.edu
Bivalacqua
Trinity J
TJ
Pierorazio
Phillip M
PM
Varkarakis
John
J
Schaeffer
Edward M
EM
Allaf
Mohamad E
ME
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011705:Pyelonephritis, Xanthogranulomatous / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult