Login to Access Video or Poster Abstract: MP68-13
Sources of Funding: none

Introduction

Xanthogranulomatous pyelonephritis (XGP) presents an imaging challenge, as the true diagnosis is usually confirmed histologically after nephrectomy. Patients with radiographically diagnosed XGP but with other circumstances that make nephrectomy an undesirable choice can include those with a solitary kidney, poor overall renal function, or the rare case of bilateral disease. Herein we describe our experience managing these types of patients with percutaneous nephrolithotomy (PCNL).

Methods

We reviewed the charts of all patients diagnosed with radiographic or pathologic XGP (n=32) at a single institution from 2009 to 2015. Patient demographics, stone characteristics, and laboratory data including renal function and microbiology were recorded. Outcomes of patients treated with PCNL including surgical complications and post-operative renal function were analyzed.

Results

We identified 11 patients (34.4%) who were diagnosed with XGP and managed with PCNL, including 2 patients with bilateral findings (total 13 renal units). Mean age was 39.1 ± 12.6 years, 91% were female, mean body mass index was 27.7 ± 8.0 kg/m², and 55% were diabetic. Median follow up was 38.5 months (IQR 12.9-64.1). A pre-operative nephrostomy tube was placed in 82% of patients and all patients had pre-operative urinary tract infections (UTI), although there was only 45% concordance between pre-operative urine and stone cultures. The mean operative time was 4.1 hours. Table 1 lists post-operative outcomes. The majority of patients (91%) had residual stones, although residual stone growth or new stone formation was rare (8%). Recurrent UTIs were seen in the majority of patients (55%). One kidney (8%) in a patient with bilateral findings was removed due to poor function. Four patients (36%) had post-operative complications: 2 Clavien grade II for additional antibiotics, and 2 Clavien grade IV for intensive care unit admissions due to infection.

Conclusions

For select patients with radiographically diagnosed XGP, PCNL is a feasible alternative to nephrectomy to preserve ipsilateral renal function, although post-operative infectious complications are common. A larger series of patients with longer-term follow-up will further elucidate the outcomes for this selective management strategy.

Funding

none