Emergency treatment of obstructive pyelonephritis: A single center series

Objective: This study aims to compare two different drainage methods, percutaneous nephrostomy (PCN) and retrograde ureteral double-J (DJ) stent insertion, in patients with obstructive pyelonephritis (OP).
Methods: The study included 77 patients who presented to the emergency department due to stones. Type of decompression treatment (PCN or DJ stent), fever, white blood cell count (WBC), C-reactive protein (CRP) levels, urine culture, blood culture, presence of additional diseases, and antibiotic treatment were evaluated for these patients. Emergency decompressive treatment was not randomly assigned. The clinician chose the appropriate treatment method based on the patient’s condition after obtaining an informed consent. Patients under the age of 18 were categorized into three subgroups: infants, children under 10 years, and adolescents. 
Results: Of the 77 patients, 31 were in the DJ stent group and 46 were in the PCN group. Patients in the PCN group exhibited significantly higher fever levels before the procedure (37.6 ± 1.0°C). Additionally, the positivity rate of urine and blood cultures was higher in the PCN group. The average time to stone treatment after infection and medical treatment, as well as fever control, was shorter in the PCN group (9 ± 2.3 days). Empiric treatment with Ceftriaxone (1 g IV) was confirmed by sensitivity results of urine or blood culture in 45% of cases. None of the patients developed advanced urosepsis after the procedure, but the resolution of infection parameters was faster in the PCN group (7 ± 3.3 days).
Conclusions: Both PCN and DJ stent insertion are effective and safe methods for managing obstructive pyelonephritis. It was observed that the PCN method under local anesthesia was useful in quickly controlling fever and allowing early surgical treatment. Finally, third-generation cephalosporin antibiotics are beneficial for empiric initial treatment.