Renal, perirenal, and pararenal abscesses: percutaneous drainage.

The efficacy of percutaneous drainage of renal, perirenal, and pararenal abscesses was assessed in 33 patients. The method eradicated the abscess in 31 patients and was palliative in two patients who were subsequently cured by surgery. Prompt defervescence was attributed to reduction of bacterial flora and institution of appropriate antibiotic treatment based on culture of the aspirate and sensitivity studies of organisms. Antibiotic changes or additions were necessary in 10 of the 33 patients, reflecting a lack of agreement with results of urine and blood cultures. The progress of percutaneous drainage was monitored with computed tomography after diffusion of dilute contrast medium in the abscess cavity. Catheter adjustments (in all patients) or additions (in 11 patients) were made necessary by the presence of demonstrated loculated compartments. Only one major complication (a pyopneumothorax) and four minor complications (bacteremias) were attributed to the percutaneous drainage procedure. The mean time for hospitalization and convalescence was substantially reduced with percutaneous drainage. The method is recommended for initial management of all renal, perirenal, and pararenal abscesses.