Results of organ-preserving treatment of acute purulent pyelonephritis

Purpose. To improve the results of organ-preserving treatment of patients with severe purulent pyelonephritis by the combined use of retroperitoneoscopic debridement and intra-arterial perfusion of drugs.

Materials and methods of research. The study was carried out in 2016–2024 on the basis of the Regional Clinical Hospital – in the urological department No2 of Barnaul. It is based on a retrospective and prospective analysis of surgical treatment of 103 patients diagnosed with acute purulent pyelonephritis. The comparison group included 56 patients operated on by classical surgical methods (lumbotomy, nephrostomy, decapsulation). The main group consists of 47 patients operated on using a hybrid surgical technique (patent No 2620756 in 2017). All patients underwent a standard general clinical and laboratory examination, examination of markers of acute inflammation and endothelial dysfunction, morphological (standard and electron microscopy) studies of the surgical material. In the comparison group, MSCT (multispiral computer tomography) with contrast was performed, in the main group, the treatment tactics of patients were determined on the basis of the CT method – renal perfusion, based on the developed criteria for the severity of renal parenchyma damage (patent No2823858 in 2024). The analysis of the functional state of the kidneys in the late follow-up period of 12 and 60 months was carried out.

Outcomes. Indications for conservative management, organ-preserving and organ-bearing treatment have been developed based on the criteria of severity of renal parenchymal damage and the pathological process based on the results of CT perfusion of the kidneys. A comparative analysis of the results of surgical intervention revealed a decrease in the number of nephrectomies from 12.5% in the comparison group to 4,3% in the study group with organ-preserving treatment. No deaths were recorded in the study group. In the comparison group, it was 3.6%.

The analysis of the functional state of the kidneys after 12 months reveals a lower indicator of signs of nephroangiosclerosis in the study group 15,8% compared to the group using classical surgical approaches 18,4%. After 60 months of follow-up, this indicator increased to 23,5% in the study group and to 72,6% in the comparison group.

Findings. CT perfusion is a valuable method for objective assessment of blood flow in the kidney in patients with acute purulent pyelonephritis. The proposed diagnostic method provides an objective assessment of both the functional and morphological state of the kidneys, which helps to choose the most rational treatment strategy. The hybrid method in combination with minimally invasive, but effective sanitation of purulent foci of the kidney and intravascular injection of alprostadil makes it possible to expand the indications for organ-preserving treatment and prevents the development of nephroangiosclerosis in the long term.