[Surgical tactics in complicated forms of acute purulent pyelonephritis in pregnancy].

Out of 3000 pregnant women observed in 1986-1999, pyodestructive forms of pyelonephritis were diagnosed in 120 women. They were treated surgically. The policy of the treatment depended on the degree of pyoseptic intoxication, severity of toxic affection of the parenchymatous organs, severity of pyodestructive changes in the kidney. Plasmapheresis expanded indications to organ-saving operations, effectively and quickly arrested purulent intoxication. Various organ-saving operations have been successfully performed in 77(64.1%) pregnant women. In 12 patients nephrostomy was uneffective. In these patients a second nephrectomy was made. Primary nephrectomy was made in 37 cases of life-threatening pyoseptic intoxication. Hard to treat bilateral pyodestructive forms of pyelonephritis were detected in 15(12.5%) women. Bilateral nephrostomy with cleaning of purulent infection foci was effective in 9 patients. It is shown that early surgical detoxication of the most affected kidney prevents development of extended pyodestructive alterations in the contralateral kidney and avoid surgical intervention.