Treatment of Kidney Abscess in Germany

Kidney abscess is one of the most severe diseases in urology. The abscess forms in the organ. If untreated, a breakthrough into the tissues surrounding the kidney, urinary tract or retroperitoneal space is possible. The pathology must only be treated surgically. German hospitals perform minimally invasive procedures and surgical interventions for abscess removal. After sparing interventions, patients recover quickly, rarely suffer from complications, and retain most of the renal parenchyma.

Content

1. Causes of the disease
2. Types of abscesses
3. Diagnostics
4. Treatment principles
5. Percutaneous drainage
6. Surgical drainage
7. Minimally invasive surgical interventions
8. Treatment in Germany with Booking Health at an affordable price

Causes of the disease

Renal abscess is usually a complication of pyelonephritis. In turn, pyelonephritis is an inflammatory disease that affects the tubular system of the kidneys. The disease is caused by nonspecific bacteria.

However, there are also other causes of the disease. The main mechanisms of infection in the renal parenchyma are:

• Urinogenic (ascending) route – pathology develops due to the inflammation of the lower urinary tract.
• Hematogenous route – infection with the blood stream (usually in pneumonia or bacterial endocarditis).
• Contact route  – spread of infection from the nearby inflamed organs, infection during surgery or injury (for example, a stab wound).

Sometimes the infection enters the kidney through the skin – the kidney abscess forms as a complication of the carbuncle.

Inflammation is rarely a consequence of a kidney infarction. Bacteria infect tissue that has died off as a result of impaired blood supply.

Diabetes mellitus and intravenous drug administration are considered risk factors for pathology as well.

Types of abscesses

Renal abscesses can be:

• Small – less than 3 cm.
• Medium – from 3 to 5 cm.
• Large – more than 5 cm.

In 95% of cases, they are single, but in 5% of cases, they are multiple. Multiple renal abscesses are most common in sepsis. The kidneys are affected by the infection through the blood from the inflamed organs, most often from the lungs.

Diagnostics

At the time of visit to the doctor, the most frequent complaints of patients are lower back pain and fever. The symptoms of the pathology are nonspecific. They are the same as in pyelonephritis, which is usually treated with the use of conservative therapies. Therefore, for the timely detection of an abscess or other complications, doctors perform an ultrasound of the kidneys. Increased intoxication, ineffectiveness of conservative therapy or severe lumbar pain may be the reasons for the examination.

The diagnosis of an abscess is based on medical imaging methods. They give the doctor information about the location, size of the abscess, their number, complications, and the severity of the pathology.

Ultrasound scanning is the main method for making the correct diagnosis in at least 70% of patients. Due to state-of-the-art equipment and experienced specialists, the accuracy of ultrasound diagnostics in the best German hospitals reaches 93%. The ultrasound scan is performed with Doppler ultrasonography in order to assess renal blood flow, as it is absent in the area of ​​the abscess.

Computed tomography is a more accurate examination. It helps to confirm the diagnosis by distinguishing the abscess from similar formations: cysts, renal tumors. The accuracy of the contrast-enhanced test exceeds 95%. With the help of the CT scan, doctors can detect purulent foci not only in the kidney, but also in the surrounding tissues.

MRI is rarely used. This is a diagnostic option for those who have contraindications for computed tomography or a contrast agent used for the CT scan.

Laboratory tests help to obtain information about the patient's health, confirm the presence of a urinary tract infection, assess kidney function, and the intensity of the inflammatory process. Urine culture or abscess punctate culture is used for bacteriological diagnostics: determination of the type of pathogen and assessment of its sensitivity to antibiotics.

Treatment principles

Kidney abscess is a severe pathology that can only be treated surgically. Conservative therapy is used as an auxiliary method for suppressing infection, reducing the risk of complications, eliminating symptoms of intoxication and relieving pain.

Abscess is the formation that must be opened. The doctor must remove the pus and ensure a stable outflow of the inflammatory fluid into the external environment through the drainage (tube). Only after the infection has been completely suppressed, the drain tubes are removed, and the wounds on the skin are sutured. The patient stays in the hospital during the entire period of treatment. However, once drainage is improved, he can be discharged for outpatient follow-up care, even if antibiotics are still being taken.

Options for kidney abscess drainage are as follows:

• Percutaneous drainage with a thick needle.
• Retroperitoneoscopic surgery.
• Open surgery.

Doctors sometimes have to resort to kidney removal surgery. This may be required in case of a severe form of pathology, multiple, very large abscesses, the presence of complications, etc. Nephrectomy is rarely performed in Europe. In countries with poorly developed medicine, the number of kidney removal surgeries reaches 45-50%.

Percutaneous drainage

Whenever possible, doctors perform percutaneous drainage for renal abscess, as this is the most sparing treatment. With the appropriate selection of patients, the procedure provides the same results as open or endoscopic surgery.

Percutaneous drainage is performed under ultrasound or CT guidance. The doctor inserts a puncture needle through the lumbar spine into the abscess. There is a mandrin inside the needle, which is a rod that closes its lumen and increases its rigidity. After insertion of the needle, the mandrin is removed and it becomes hollow.

Samples of pus are obtained through the needle, which are then sent for bacteriological examination. Pus is cultured in order to check which microorganisms will grow on the nutrient medium. Diagnostics take about 2 days. According to the results, the sensitivity of the isolated flora to antibiotics is assessed. The doctor can use the information received to correct the antibiotic therapy regimen if it is not effective enough.

The doctor inserts a metal guidewire through a hollow needle. The next step is bougienage, which implies dilation of the puncture hole. A thick tube (drainage) is inserted into it along the guidewire, through which pus flows down. It is fixed to the skin with sutures. If the size of the purulent cavity exceeds 5-6 cm, the doctor can place two drains.

The tube is always in the patient's lumbar spine. It is removed on average after 8-12 days – 3-4 days after the cessation of pus discharge and normalization of body temperature. Not only purulent contents are evacuated through the tube, but also the cavity of the renal abscess is washed with antiseptics.

The method has the following advantages:

• Minimal trauma rate.
• Preservation of kidney function.
• Fast recovery.
• Health safety.
• No need for general anesthesia.
• Procedure can be carried out for patients in a severe condition, for whom open surgery is contraindicated due to their health status.
• Kidney abscesses of almost any size can be removed.
• Not only the renal abscess, but also the retroperitoneal space can be drained in case of the abscess breakthrough.

Several tens of milliliters of pus are usually removed within a single procedure. With the formation of large abscesses and a breakthrough into the retroperitoneal space, simultaneous evacuation of up to 200-300 ml of pus is possible.

Surgical drainage

The standard treatment for renal abscess is a lumbotomy (an incision in the lower back) and surgical drainage. This is a traumatic operation, after which it takes a long time to recover, and 25% of patients develop serious complications. It can be performed in the following cases:

• Multiple abscesses.
• Abscess is complicated by a purulent inflammation of the tissues surrounding the kidney.
• Inconvenient localization of the renal abscess (anterior surface of the kidney) for percutaneous puncture.
• High density of the capsule.
• Failed attempt of percutaneous drainage.

Minimally invasive surgical interventions

In Germany, patients with renal abscess undergo minimally invasive surgery through short incisions. Doctors use retroperitoneoscopic access, which means that thin long instruments with a video camera are inserted into the retroperitoneal space. The doctor can then mobilize the kidney, excise the pus cavity, and drain the wound.

Like open surgery, lumboscopy is performed under general anesthesia. It is possible to remove renal abscesses of almost any localization. However, it is technically more complex for a doctor to perform excision of purulent foci located on the upper pole and anterior surface of the kidney.

Minimally invasive interventions have the following advantages:

• Less trauma rate as compared to open surgery.
• Such interventions can be performed for the treatment of almost all cases of renal abscess, regardless of its size and location.
• Сomplicated cases of pathology can be treated.
• Rapid recovery as compared to lumbotomy.
• Reduced blood loss.
• Reduced hospital stay.
• Lower risk of complications.

It is this option of surgical treatment that is preferred in Germany if percutaneous drainage cannot provide the desired therapeutic result.

Treatment in Germany with Booking Health at an affordable price

To undergo treatment of kidney abscess in one of the German hospitals, you can use the services of the Booking Health company. On our website, you can see the information about the cost of treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Treatment in German hospitals will be easier and faster for you, and the cost of treatment will be lower.

You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide information on treatment in Germany. Booking Health will fully organize your trip to this country. We will provide the following benefits for you:

• We will choose the best German hospital, whose doctors specialize in kidney abscess treatment.
• We will help you overcome the language barrier and establish communication with the attending physician of the German hospital.
• We will reduce the waiting time for the medical care program. You will undergo treatment on the most suitable dates.
• We will reduce the price. The cost of treatment in Germany will be lower due to the lack of overpricing and additional coefficients for foreign patients.
• We will take care of all organizational issues: we will draw up documents, meet you in Germany and take you to the hospital, book a hotel, and provide interpreting services.
• We will prepare a program and translate medical records. You do not have to repeat the previously performed diagnostic procedures.
• We will help you keep in touch with doctors after the completion of treatment in Germany.
• We will organize additional examinations and treatment in a German hospital.
• We will buy medicines in Germany and forward them to your native country.

Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help you reduce the cost of treatment, organize your trip to the German hospital, and you will only have to focus on restoring your health.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed