Perinephric Abscess — Open Surgery Drainage: treatment in the Best Hospitals of Germany

A perinephric abscess is an abscess located near the kidney, resulting from the death of adipose tissue. In 75% of cases, this is a complication of urinary tract infection, and, in 25% of cases, the infection penetrates into the tissues surrounding the kidney through the blood from distant purulent foci. In severe cases, inflammation spreads to the psoas and transverse muscles, as well as to the abdominal cavity and pelvis.

Even in such situations, with the timely provision of medical care, the disease can be successfully cured. Doctors in Germany treat patients with antibiotics and perform a minimally invasive percutaneous puncture for an abscess. In rare cases, surgery may be required. Should a surgical intervention be required, German urologists strive to preserve the kidney, and surgery is often performed with the use of minimally invasive techniques through short incisions.

Content

1. Treatment tactics
2. Conservative therapy
3. Minimally invasive and surgical treatment

Treatment tactics

The management of patients depends on the size and location of an abscess, and the presence of comorbidities. After the start of therapy, tactics may change depending on the results achieved.

Primary care standards for patients are as follows: 

• abscesses up to 3 cm can be treated with antibiotics without surgery and invasive procedures;
• abscesses larger than 3 cm require a percutaneous drainage to evacuate pus;
• if conservative therapy for an abscess size of up to 3 cm is ineffective, a percutaneous drainage may be indicated;
• if conservative therapy is not effective, and a percutaneous drainage is ineffective or impossible (for example, due to the inconvenient location of the abscess), an open surgery drainage becomes an option of choice;
• for patients with chronically infected and atrophic kidney, a nephrectomy (kidney removal surgery) is performed.

Conservative therapy

Since a perinephric abscess is caused by bacteria, antibiotic therapy is the mainstay of treatment. Antibiotics are prescribed from the very beginning of the disease, immediately after sampling material for bacteriological diagnostics.

Antibiotics are initially prescribed empirically, that is, against the most common pathogens. This is Staphylococcus aureus, or Enterobacteriaceae. If an abscess has developed against the background of pyelonephritis, it is most likely caused by Escherichia coli.

Most patients undergo a bacteriological examination. Biomaterial (usually pus obtained as a result of an abscess puncture) is placed on a nutrient medium. It grows colonies of microorganisms, which are then identified. In addition, during the examination, the sensitivity of isolated bacteria to various antibacterial agents is determined.

Given the antibiogram data, doctors can adjust the treatment regimen after 2-3 days. They prescribe the drug to which the pathogen is highly sensitive. Sometimes the scheme does not have to be changed. If the initially prescribed antibiotics work well, they continue to be used further.

The course of antibiotic therapy lasts 2-3 weeks. A patient can first receive drugs intravenously, but after achieving initial treatment results, further therapy will be carried out with oral forms of antibiotics.

Minimally invasive and surgical treatment

Invasive treatment is required for an abscess size of 3 cm or more, as well as for insufficient effectiveness of conservative therapy.

The standard of invasive treatment in Germany is a percutaneous abscess puncture. A doctor inserts a thick needle into the cavity with pus and evacuates it under ultrasound or CT guidance. A specialist can inject antimicrobial and anti-inflammatory drugs. A drainage is left in the wound and pus flows through it. After the amount of fluid secreted decreases significantly, the drainage will be removed, and the patient will be subsequently treated with antibiotics.

Surgery for perinephric abscess treatment in Germany is very rarely used. This can become an option if:

• the disease is advanced and an abscess is very large; 
• the inflammation has spread to neighboring organs and tissues;
• the kidney is practically destroyed by the disease;
• a percutaneous drainage is hindered by the location of the abscess;
• concomitant urolithiasis or vesicoureteral reflux.

In the overwhelming majority of cases, doctors at German hospitals carry out organ-preserving treatment. They remove the abscess and make drainage, but preserve the kidney. A nephrectomy is rarely required.

In the classical version, operations for perinephric abscess are performed through large incisions. However, German Urology Centers also perform laparoscopic, retroperitoneoscopic, and robot-assisted surgeries. They are more sparing, safe, and are performed with thin long instruments or slave manipulators of a robotic surgeon through short incisions. After such operations, the rehabilitation period is reduced to a minimum.

You can go to Germany to get medical care for your perinephric abscess. It is worth starting treatment as soon as possible. The specialists at the Booking Health company will arrange for you an urgent appointment with a urologist in one of the clinics in Germany, if required. On our website, you can find the cost of treatment and make your appointment at a clinic at the best price. We will help you to find a hospital in Germany and organize your trip.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

MedicineNet

Healthline

NHS