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

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of Adult and Pediatric Urology, Andrology

The Department of Adult and Pediatric Urology, Andrology offers the full range of services in the areas of its specialization. Men and boys with diseases of the reproductive system can be diagnosed and treated in the medical facility. Doctors also treat infertility and erectile dysfunction. Medical care is provided to men and women with diseases of the urinary system, namely kidneys, ureters, bladder, and urethra. The department is certified as the Prostate Cancer Center by the German Cancer Society (DKG), which indicates the excellent quality of the services provided in this area. The department's urologists have a perfect command of the innovative treatment methods, including holmium laser enucleation of the prostate (HoLEP), photodynamic therapy, and da Vinci robot-assisted surgery. The department employs comprehensively trained and experienced doctors who apply advanced medical achievements in their practice. Each patient is provided with an individual approach, considering their specific needs and wishes.

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people Interpreter up to 8 hours
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University Hospital Ulm

8.7/10
location_onGermany, Ulm

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top medical institutions in Germany for prostate cancer treatment! The department offers the full range of high-precision diagnostics and effective treatment of diseases of the urogenital system, genitals in men and boys. It treats about 3,000 inpatients and 9,000 outpatients with the clinical cases of varying severity every year.

Urology Clinic Munich-Planegg Munich

10/10
location_onGermany, Munich

Department of Adult and Pediatric Urology, Andrology

The Department of Adult and Pediatric Urology, Andrology offers the full range of services for the diagnostics and treatment of urologic diseases in men and children, as well as urogynecologic disorders in women. One of the priority focuses of the department's specialization is the restoration of potency in men. According to the international ratings, this is the best hospital in Europe, where a team of urologists effectively treats erectile dysfunction. Another key focus of the department's work is on the treatment of benign and malignant prostate diseases. To treat prostate cancer, the doctors perform low-traumatic robot-assisted interventions using the very latest da Vinci® XI HD surgical system. The therapeutic offer is complemented by the treatment of pathologies of the kidneys, ureters, bladder, testicles and penis. In the field of pediatric urology, the correction of congenital malformations of the reproductive system in boys is of particular interest. The department's doctors are professionals in their area of specialization, so the patients can be sure that they will certainly find an effective solution even for the most complex clinical case.

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers all types of modern diagnostic and therapeutic services for patients with urologic diseases. Of particular interest is the treatment of urogenital tumors in men and urogynecological diseases. The department also specializes in kidney transplantation, which is carried out within the specialized center. This center is the largest in Germany and Europe and annually demonstrates high treatment success rates. In addition, the department's competence covers the treatment of urological problems in boys of all age groups.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department offers the full range of diagnostics and treatment of the urinary system in men and boys. The department has a long history, rich traditions, and is also a recognized center of excellence in the treatment of all urological diseases. The department specializes in the treatment of malignant urological diseases, reconstructive surgery, pediatric urology, treatment of urinary tract dysfunction and kidney stone disease.

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

Department of Urology

According to the Focus magazine, the Department of Urology ranks among the top German medical institutions specializing in prostate cancer treatment! The department offers the full range of high-precision diagnostic studies and effective therapeutic options for men with diseases of the genitourinary system. The doctors of the department specialize in the treatment of prostate cancer, benign prostatic hyperplasia, kidney, testicular cancers, urolithiasis, erectile dysfunction and urinary incontinence. There are also excellent qualifications in the field of reconstructive urology.

University Hospital Jena

8.9/10
location_onGermany, Jena

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers the full range of advanced methods of diagnostics and treatment of all genitourinary system diseases, including in children. Of particular interest is the treatment of patients with urinary tract and kidney tumors, kidney stone disease, prostate diseases, treatment of urinary incontinence, andrologic disorders and urological problems in young patients. Since 2010, the department has been certified as the Prostate Cancer Center (certified by the German Cancer Society, recertified in 2016).

University Hospital Erlangen

9.1/10
location_onGermany, Erlangen

Department of Adult and Pediatric Urology, Andrology

According to the Focus magazine, the Department of Adult and Pediatric Urology, Andrology ranks among the best departments in Germany specializing in prostate cancer treatment! The department offers the full range of diagnostic and therapeutic services in the fields of its expertise. The department's medical team specializes in the treatment of diseases of the urinary tract in women and men, as well as in the treatment of pathologies of the reproductive system in adult men and children, andrological diseases in men. The primary focus of the clinical practice of the department's doctors is medical care for patients with kidney, bladder, ureteral, urethral, prostate, testicular and penile cancers. The department's specialists keep pace with medical innovations, so most surgical interventions are performed using sparing laparoscopic techniques that do not require large incisions in the skin and soft tissues. To treat prostate cancer, doctors successfully use robot-assisted prostatectomy with the da Vinci surgical system. This intervention has many advantages over classical surgery and is available only in the best hospitals in the world. In addition, the department's doctors demonstrate excellent results in the treatment of kidney stone disease, urinary incontinence and pelvic organ prolapse. A specially trained team of doctors has been formed for the treatment of urological pathologies in children. Of particular interest is the correction of congenital genitourinary anomalies in young patients.

University Hospital Halle (Saale)

9.6/10
location_onGermany, Halle

Department of Urology

According to the Focus magazine, the Department of Urology ranks among the top medical institutions in Germany specializing in prostate cancer treatment! The department offers the full range of diagnostics and treatment of urinary tract diseases in men. Of particular interest are kidney transplantation, treatment of benign and malignant urologic diseases. The department has become one of the pioneers in the field of minimally invasive robot-assisted surgery (da Vinci), thanks to which it has exceptional experience in this area. In addition, the department became the second medical facility in Germany, which performed kidney transplantation using a da Vinci robotic system.

University Hospital Hamburg-Eppendorf

9.2/10
location_onGermany, Hamburg

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department has all the diagnostic and therapeutic options to provide first-class medical care for patients with diseases of the genitourinary system. The priority focus is reconstructive urology, in particular, the whole range of urethral surgery, procedures for the treatment of urinary incontinence (including artificial sphincter implantation, sling procedures), as well as penile surgery for congenital or acquired malformations, prosthetics in case of erectile dysfunction.

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

Department of Adult and Pediatric Urology

The Department of Adult and Pediatric Urology offers the diagnostics and treatment of all diseases of the urinary system organs (kidneys, ureters, bladder, urethra, etc.), as well as of the male reproductive organs in adults and children. The department specializes in the surgical and drug treatment of oncological diseases, correction of complex malformations, and plastic reconstructive urology. The department is the certified Prostate Cancer Centre.

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

Department of Adult and Pediatric Urology

The Department of Adult and Pediatric Urology provides high-precision diagnostics and effective treatment of the full range of diseases of the kidneys, urinary tract, bladder, prostate, testicles and their appendages, vas deferens and penis. The treatment of urologic cancers is of particular interest. The focus of pediatric urologists is on young patients with congenital and acquired malformations of the genitourinary system. The department has its in-house advanced operating rooms, an X-ray unit, and two stations with 57 beds. The high quality of medical care is confirmed by many prestigious certificates, including the DEKRA certificate and the certificate of the European Board of Urology. As one of the best urologic facilities in Germany and a leading urology clinic in Munich, the department has been offering patients the daVinci robot-assisted surgery since 2009, which has many advantages for patients: minimal pain, speedy recovery, the highest level of precision compared to conventional surgical interventions.

University Hospital RWTH Aachen

8.7/10
location_onGermany, Aachen

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers services for the diagnostics and treatment of diseases of the kidneys, urinary tract and pathologies of the reproductive organs in men. The therapeutic options are complemented by the treatment of urological problems in children. The department's doctors focus on the patients with oncopathologies (prostate cancer, renal cell cancer, bladder cancer, testicular cancer). Of particular interest is minimally invasive therapy of stones in the kidneys, ureters and bladder. The doctors have in their arsenal conventional and the very latest conservative, drug and surgical therapies, which allow them to achieve the best result in clinical cases of varying severity.

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department offers the widest range of modern diagnostic and therapeutic methods for accurate detection and treatment of diseases of the genitourinary system in men and boys. The priority focus of the department is the treatment of prostate cancer (certification of the German Cancer Society).

University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

Department of Urology

According to the Focus magazine, the Department of Urology is included in the ranking of the top German departments for prostate cancer treatment! The department offers the full range of diagnostics and treatment of diseases of the kidneys, bladder and urinary tract, male genital organs. The department has advanced experience in urologic surgery and is one of the most reputable medical institutions specializing in the treatment of benign and malignant prostate diseases. In 2009, the department was certified by the German Cancer Society as the Prostate Cancer Center.

University Hospital Bonn

9.2/10
location_onGermany, Bonn

Department of Adult and Pediatric Urology

According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department deals with the diagnostics, conservative and surgical treatment of diseases of the genitourinary system in men and boys. If necessary, surgical treatment may be provided with the use of sparing minimally invasive techniques, which allows to ensure early recovery for the patient. In the treatment of benign prostatic hyperplasia, kidney stone disease, ultramodern laser technologies are widely used. The department treats more than 1,800 inpatients and about 5,000 outpatients every year.

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

Doctors use antibiotics and a percutaneous drainage to treat the disease. A surgical drainage is a less required option, and, in very rare cases, doctors have to remove the kidney.

You can undergo your treatment at one of the following hospitals: Urology Clinic Munich-Planegg Munich, University Hospital Ulm, or University Hospital of Ludwig Maximilian University of Munich.

We will take care of the organization of your trip if you make an appointment at the hospital through the Booking Health service. Doctors at the Booking Health company will study the results of your diagnostic examinations, recommend the best treatment method, and monitor the course of therapy. The Booking Health managers will help you to apply for a visa, get to the clinic, book accommodation, process all the necessary documents, and also advise on any issues. You will be accompanied by an interpreter during your 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




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