Introduction: To evaluate therapeutic results till 5 years after therapy of obstructive pyelonephritis (OPN) emphasizing regular follow-up. Material and Methods: During 5 years, 57 patients with OPN were treated. The patients' charts were reviewed retrospectively for clinical data. These were completed by a questionnaire. Results: In the group of 57 patients (average age 56 years), about two third were women. Urolithiasis (65%) and tumors (21%) were the main causes of obstruction; fever (91%) and loin pain (86%) the main symptoms. Three fourth of the patients showed renal insufficiency and nearly 50% anemia. E. coli and Proteus spp. were the dominating organisms. Sonography detected obstruction in 93% cases. In one third of cases, CT scan was added; 81% percutaneous nephrostomy and 19% ureteral stenting were the initial methods of urinary drainage. During therapy, 23% nephrectomies (19% complete, 4% partial) were performed. Long-term follow-up showed 11% recurrent OPN and 33% recurrent UTI. Conclusions: After diagnosis of OPN, primary nephrostomy or ureteral stenting and antibiotic therapy are the first measures. If recurrent urinary tract infections or OPN occur, long-term follow-up and low-dose antibiotic prophylaxis may be discussed.

Keywords:
Urinary tract infection, Renal obstruction, Obstructive pyelonephritis, Pyonephrosis, Percutaneous nephrostomy, Long-term results
1.
Robins SA, Fischmann J: Hydronephrosis: a radiologic classification based on anatomical variations. Radiology 1948;50:632-638.
2.
Demertzis J, Menias CO: State of the art: imaging of renal infections. Emerg Radiol 2007;14:13-22.
3.
Tambo M, Okegawa T, Shishido T, Higashihara E, Nutahara K: Predictors of septic shock in obstructive acute pyelonephritis. World J Urol 2014;32:803-811.
4.
Browne RFJ, Zwirewich C, Torreggiani WC: Imaging of urinary tract infection in the adult. Eur Radiol 2004;14:E168-E183.
5.
Bruns T: Harnwegsinfektionen, ed 2. Bremen, Uni-Med, 2006.
6.
Soulen MC, Fishman EK, Goldman SM, Gatewood B: Bacterial renal infection: role of CT. Radiology 1989;171:703-707.
7.
Vahlensieck W: Pyelonephritis und Nierenabszess; in Schmelz HU, Sparwasser C, Weidner W (eds): Facharztwissen Urologie Differenzierte Diagnostik und Therapie, ed 3. Heidelberg, Springer, 2014, pp 13-36.
8.
Seitz C, Fajkovic H: Epidemiological gender-specific aspects in urolithiasis. World J Urol 2013;31:1087-1092.
9.
Vahlensieck EW, Bach D, Hesse A: Incidence, prevalence and mortalitiy of urolithiasis in the German Federal Republic. Urol Res 1982;10:161-164.
10.
Ifergan J, Pommier R, Brion MC, Glas L, Rocher L, Bellin MF: Imaging in upper urinary tract infections. Diagn Interv Imaging 2012;93:509-519.
11.
Ng CK, Yip SK, Sim LS, Tan BH, Wong MY, Tan BS, Htoo A: Outcome of percutaneous nephrostomy for the management of pyonephrosis. Asian J Surg 2002;25:215-219.
12.
Bartsch GC, Kuefer R, Gschwend JE, de Petriconi R, Hautmann RE, Volkmer BG: Hydronephrosis as a prognostic marker in a bladder cancer in cystectomy-only series. Eur Urol 2007;51:690-697.
13.
Christoph F, Weikert S, Müller M, Miller K, Schrader M: How septic is urosepsis? Clinical course of infected hydronephrosis and therapeutic strategies. World J Urol 2005;23;243-247.
14.
da Costa JB, Cornu JN, Levgraverend D, Cordel H, Ridel C, Letendre J, Traxer O, Tligui M, Haab F: Pyonephrosis caused by Salmonella typhi: a case report. Urol Int 2014, [Epub ahead of print].
15.
Zhang X, Niu S, Zhang L: Antimicrobial susceptibilities and clinical characterization of Pseudomonas aeruginosa isolates from urinary tract infections. Urol Int 2014;93;464-469.
16.
van Nieuwkoop C, Hoppe BP, Bonten TN, van't Wout JW, Aarts NJ, Mertens BJ, Leyten EM, Koster T, Wattel-Louis GH, Delfos NM, Ablij HC, Elzevier HW, van Dissel JT: Predicting the need for radiologic imaging in adults with febrile urinary tract infection. Clin Infect Dis 2010;51:1266-1272.
17.
Kawashima A, Sandler CM, Goldman SM: Imaging in acute renal infection. BJU Int 2000;86(suppl 1):70-79.
18.
Heyns CF: Urinary tract infections in obstruction of the urinary tract; in Naber KG, Schaeffer AJ, Heyns C, Matsumoto T, Shoskes DA, Bjerklund Johansen TE (eds): Urogenital Infections. European Association of Urology, 2010, pp 452-480.
19.
Lin WR, Chen M, Hsu JM, Wang CH: Emphysematous pyelonephritis: patient characteristics and management approach. Urol Int 2014;93:29-33.
20.
Pearle MS, Pierce HL, Miller Gl, Summa JA, Mutz JM, Petty BA, Roehrborn CG, Kryger JV, Nakada SY: Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 1998;160:1260-1264.
21.
Ramsey S, Robertson A, Ablett MJ, Meddings RN, Hollins GW, Little B: Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi. J Endourol 2010;24:185-189.
22.
Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C: Guidelines on Urolithiasis. European Association Urology, 2013.
23.
Borofsky MS, Walter D, Shah O, Goldfarb DS, Mues AC, Makarov DV: Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi. J Urol 2013;189:946-951.
24.
Li AC, Regalado SP: Emergent percutaneous nephrostomy for the diagnosis and management of pyonephrosis. Semin Intervent Radiol 2012;29:218-225.
25.
Heyns CF: Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder. World J Urol 2012;30:77-83.
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2015
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