Singh Anshuman, K R Surag, Choudhary Anupam, Reddy Suraj Jayadeva, Gali Kasi Viswanath, Shah Abhijit
Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Curr Urol. 2025 Jul;19(4):263-268. doi: 10.1097/CU9.0000000000000232. Epub 2023 Oct 20.
Management of renal calculi in the presence of emphysematous pyelonephritis (EPN) is challenging. The optimal management strategy for patients with EPN and renal calculi remains unclear. This study aimed to evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the management of these patients and to provide insights into the postoperative outcomes and complications of PCNL according to the modified Clavien-Dindo classification.
This retrospective study included patients with EPN and renal stones who underwent PCNL, after initial conservative management, between January 2012 and December 2021. Patient demographics, presenting symptoms, features of septicemia, preoperative drainage, postoperative complications, and outcomes were recorded. Postoperative complications were categorized according to the modified Clavien-Dindo classification.
A total of 48 patients with EPN and renal calculi were included in this study. Percutaneous nephrolithotomy was performed 4-6 weeks later after obtaining a negative urine culture or under appropriate antibiotic coverage if the culture was unsterile. Of the total, 39 (81.25%) patients had postoperative complications, but only 9 (18.75%) patients had grade III or higher complications. Of these, 3 (6.25%) patients had grade IIIa complications, 3 (6.25%) had grade IIIb complications, 2 (4.1%) had grade IVa complications, and 1 (2.08%) had grade IVb complications and was admitted to the intensive care. No mortality was observed during the postoperative period.
Initial conservative management of EPN followed by PCNL after initial infection control is an effective strategy for managing these patients. Patients with higher EPN grades have a higher risk of major postoperative complications after PCNL for renal stones. Specifically, patients with an EPN class 3 or 4 had a higher risk of complications than those with an EPN class 2 or lower. Patients with EPN class 1 have a relatively uncomplicated postoperative course after PCNL.
存在气肿性肾盂肾炎（EPN）时肾结石的管理具有挑战性。EPN合并肾结石患者的最佳管理策略仍不明确。本研究旨在评估经皮肾镜取石术（PCNL）治疗这些患者的安全性和有效性，并根据改良的Clavien-Dindo分类法深入了解PCNL的术后结局和并发症。
本回顾性研究纳入了2012年1月至2021年12月期间在初始保守治疗后接受PCNL的EPN合并肾结石患者。记录患者的人口统计学资料、临床表现、败血症特征、术前引流情况、术后并发症及结局。术后并发症根据改良的Clavien-Dindo分类法进行分类。
本研究共纳入48例EPN合并肾结石患者。在尿培养转阴后4 - 6周进行经皮肾镜取石术，若培养结果未无菌，则在适当的抗生素覆盖下进行。其中，39例（81.25%）患者有术后并发症，但只有9例（18.75%）患者出现III级或更高等级的并发症。其中，3例（6.25%）患者出现IIIa级并发症，3例（6.25%）出现IIIb级并发症，2例（4.1%）出现IVa级并发症，1例（2.08%）出现IVb级并发症并入住重症监护病房。术后期间未观察到死亡病例。
EPN的初始保守治疗，继以初始感染控制后的PCNL，是治疗这些患者的有效策略。EPN分级较高的患者在PCNL治疗肾结石后发生主要术后并发症的风险较高。具体而言，EPN 3级或4级的患者比EPN 2级或更低级别的患者并发症风险更高。EPN 1级的患者在PCNL术后的病程相对不复杂。
