[Results and substantiation of surgical strategy in acute suppurative-destructive pyelonephritis in pregnant women].

The effectiveness of treatment of acute purulent pyelonephritis in 2.256 pregnant women from 1986 to 1992 was analysed. 95-97% of them had diffuse purulent (nondestructive) pyelonephritis which was cured by drug treatment. Pyodestructive manifestations (apostematosis, carbuncle, abscess of the kidney) of uni- (84.8%) and bilateral (15.2%) pyelonephritis were found in 85 (3.8%) of the patients. Signs of pyoseptic intoxication predominated in the clinical picture. Antibacterial and detoxification therapy was applied in the pre- and postoperative periods. The choice of the surgical tactics and operative method was based on the peculiarities of the clinical course, the revealed complications, and the anatomical changes in the kidney. Nephrostomy and antibacterial therapy are sufficient for curing the apostematic form. Patients with a bilateral affection were treated by operative stage-by-stage kidney drainage (nephrostomy). When economical operations were ineffective clinically (9.4%), secondary nephrectomy was indicated. Primary nephrectomy is an adequate surgical intervention in cases of a total destructive process in the kidney, grave septic manifestations, and a toxic response of the liver. The high proportion of nephrectomies (37.6%) is explained by the clinicoanatomical severity of focal-purulent pyelonephritis and its complications (sepsis) which hazard the life in pregnancy. Pliant surgical tactics in the treatment of severe forms of pyodestructive pyelonephritis ensured clinical cure of 96.5% of patients and uneventful delivery in 91.8% of cases. Death occurred from sepsis and bacteriotoxic shock which developed due to purulent pyelonephritis of pregnancy.