title: Nephroureterectomy for emphysematous pyelonephritis: An aggressive approach is sometimes necessary. A case report and literature review.
abstract: BACKGROUND
  Emphysematous pyelonephritis (EPN) is a life-threatening urological emergency. A high index of suspicion is required for diagnosis as such patients may present to physicians with typical features of pyelonephritis.
  
  
  METHODS
  A 67 year old lady presented atypically to the Emergency Department with symptoms of renal colic. The diagnosis of emphysematous pyelonephritis was established on prompt CT scanning. She did not respond to conservative management. Due to acute, critical deterioration, she underwent a radical right nephroureterectomy. The resected kidney involved a long segment of necrotic, gangrenous ureter. The patient had a smooth post-operative recovery and was successfully discharged. She remains well on follow-up after one year.
  
  
  CONCLUSIONS
  Early radiological diagnosis is imperative for risk stratification of EPN. Current evidence recommends percutaneous catheter drainage with interval nephrectomy as the gold standard treatment. We review the literature for pathophysiology and clinical prognostic factors. This case adds onto the limited evidence base on ureteric involvement in EPN, suggesting a revision of EPN classification.
  
  
  CONCLUSIONS
  Further research on ureteric involvement and treatment outcomes in EPN is required. Even in the current era of minimally invasive surgery and renal preservation therapies, early open nephrectomy still has a role in the management of EPN.
authors: Department of Urology, Wexham Park Hospital, Frimley Health NHS Trust, Berkshire, SL2 4HL, United Kingdom. Electronic address: gaelromy@gmail.com.
authors: Gael R
authors: GR
authors: Nana
authors: Department of Urology, Wexham Park Hospital, Frimley Health NHS Trust, Berkshire, SL2 4HL, United Kingdom.
authors: Andrew
authors: A
authors: Brodie
authors: Department of Urology, Wexham Park Hospital, Frimley Health NHS Trust, Berkshire, SL2 4HL, United Kingdom.
authors: Waseem
authors: W
authors: Akhter
authors: Department of Urology, Wexham Park Hospital, Frimley Health NHS Trust, Berkshire, SL2 4HL, United Kingdom.
authors: Omer
authors: O
authors: Karim
authors: Department of Urology, Wexham Park Hospital, Frimley Health NHS Trust, Berkshire, SL2 4HL, United Kingdom.
authors: Hanif
authors: H
authors: Motiwala
keywords: Emphysematous pyelonephritis; Nephrectomy; Nephroureterectomy; Review; Urology