Clinical outcomes of nonoperative management in emphysematous urinary tract infections

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.