From the Research
Stenting in emphysematous pyelonephritis (EPN) is indicated when there is urinary tract obstruction that prevents adequate drainage of infected material, as evidenced by the most recent study 1. The primary management of EPN involves aggressive antibiotic therapy, fluid resuscitation, and drainage of the infected collecting system.
- A double-J ureteral stent should be placed when imaging (CT scan) demonstrates obstructive uropathy, typically from stones, strictures, or external compression, which can worsen the infection by trapping gas-forming bacteria and purulent material.
- Stenting is particularly important in patients with Class 3 or 4 EPN (based on Huang and Tseng classification) who have extensive gas formation and renal parenchymal destruction.
- The procedure should be performed promptly after initial stabilization with antibiotics, typically within 24-48 hours of diagnosis.
- Stenting provides immediate decompression of the collecting system, facilitates drainage of purulent material, and may help avoid more invasive procedures like nephrectomy in some cases. However, stenting alone is often insufficient for severe cases with extensive gas formation or abscess, where percutaneous drainage or surgical intervention may be necessary, as suggested by 2 and 3. The stent typically remains in place for 4-6 weeks while the infection resolves and any underlying obstruction is addressed definitively. It is essential to note that the management approach may vary depending on the patient's condition, and a conservative management strategy, including stenting, can be effective in some cases, as reported in 4.