Buchok O. The choice of the optimal drainage method of upper urinary tracts in patients with acute obstructive pyelonephritis

The thesis is dedicated to the aspects determining the optimal treatment strategy in patients with acute obstructive pyelonephritis (AOP). This paper analyzes comprehensive treatment of 475 patients with AOP. After being diagnosed all patients were performed drainage of the upper urinary tracts using percutaneous nephrostomy (PCN), ureteral stenting (US) or ureteral catheterization (UC). High efficacy of PCN in the treatment of patients with AOP has been determined due to comparative analysis of treatment results in the groups of patients mentioned above. It has been defined that technical success of PCN is 98.9%. It has been distinguished that PCN is significantly safer drainage method of upper urinary tracts than UC and US in patients with AOP and requires the least duration of drainage (7.2±1.3 days to 13.8±1.7 days and 12.3±1.4 days, respectively). The overall incidence of complications of PCN did not exceed 15.5% and was lower than in US - 28.6% (p <0.05), and UC - 64.8% (p <0.05). It was established that performing PCN in patients with AOP associated with higher life quality and better restoration of the affected kidney function compared to US and UC. The use of 3-rd generation cephalosporin antibiotic for empirical antibacterial treatment in patients with AOP shows the highest indices of microbiological and clinical efficacy in combination with PCN (91.2% and 95.2% respectively). Thus, the use of PCN is the priority method of eliminating obstruction in patients with AOP excluding cases with contraindications.