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Clinical Outcomes of Nonoperative Management in Emphysematous Urinary Tract Infections.
MedLine Citation:
PMID:  22513034     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the clinical outcomes of nonoperative management of emphysematous urinary tract infections (EUTIs). METHODS: We retrospectively reviewed 28 consecutive cases of EUTI over a 5-year period, all of which were treated with urinary drainage and medical management without surgical intervention. EUTIs were classified as either emphysematous pyelonephritis (EP) or emphysematous cystitis (EC). Clinical, diagnostic, and therapeutic data were analyzed. RESULTS: Of the 28 patients evaluated, 13 had EP and 15 had EC, all of which were diagnosed by computed tomography. Of EP patients, the mean age was 54 years with a median serum creatinine (sCr) of 1.8 mg/dL (estimated glomerular filtration rate [eGFR] 38 mL/min/1.73 m(2)). Obstructive uropathy was present in 69%, and 100% received antibiotics and percutaneous drainage without mortality. Median follow-up was 10 months without any subsequent nephrectomy and median sCr decreased to 1.1 mg/dL (P = .04) and eGFR increased to 63.5 mL/min/1.73 m(2) (P = .06). Of EC patients, the mean age was 60 years with a median sCr of 1.3 mg/dL (eGFR 55 mL/min/1.73 m(2)). All were managed with antibiotics and catheter drainage with a single mortality (7%). Median follow-up was 2 months and median sCr decreased to 1.2 mg/dL (P = .83) and eGFR increased to 46 mL/min/1.73 m(2) (P = .68). The most common causative pathogen was Escherichia coli for both EP (54%) and EC (53%). CONCLUSION: Early detection, medical management, and urinary drainage of EUTI can result in a favorable prognosis. This strategy results in low levels of mortality without the need for surgical intervention and can preserve renal function.
Authors:
Marc A Bjurlin; Stephen D Hurley; Dae Y Kim; Matthew R Cohn; Michael D Jordan; Ronald Kim; Naveen Divakaruni; Courtney M P Hollowell
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-16
Journal Detail:
Title:  Urology     Volume:  -     ISSN:  1527-9995     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Division of Urology, Department of Surgery, Cook County Hospital, Cook County Health and Hospitals System, Chicago, IL, USA.
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