An integrated approach to the treatment of purulent pyelonephritis

   Objective. To improve the results of organ-preserving treatment of acute purulent pyelonephritis by the combined use of retroperitoneoscopic sanitation of the purulent focus and prolonged intra-arterial perfusion of drugs.

   Material and methods. As part of the study conducted in the second urology department of the Regional Clinical Hospital, the authors examined and operated on 30 patients with purulent pyelonephritis using an innovative hybrid technique (patent No 2620756). This technique involves the removal of the affected areas of the kidney by retroperitoneoscopic access, followed by a regional arterial infusion of alprostadil through a catheter inserted endovascularly into the renal artery. Upon admission, all patients underwent a general clinical examination. Surgical materials were subjected to microbiological and morphological analysis. To assess the condition of the kidneys before and after surgery, MSCT with bolus contrast and duplex scanning of the renal vessels were performed.

   Results. On the first day after surgery, patients noted pain reduction in the area of the operated kidney. Comparison of CT data before and after the intervention showed the elimination of destructive foci in the kidney and improvement of blood supply in the affected area. Morphological examination revealed leukocyte infiltration and edema, accumulations of platelets in the lumen of dilated peritubular capillaries. In all cases, it was possible to avoid removal of the kidneys.

   Conclusion. The proposed method of treating purulent pyelonephritis, including an integrated approach to restoring blood circulation in the kidney and improving the access of antibiotics to the organ parenchyma, demonstrates its high efficiency. This method provides a targeted effect on each level of the vascular system and kidney tissues, affecting areas with microabscesses.

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