Dr Jo Schoeman
Urological Surgeon

        

Drainage Renal abcess

Product Summary: AMA rates

To drain a large abcess causing low grade to high temperatures. Percutaneous or open procedure for the drainage of abcess.

Item Number: 36537, 105

Why is it done?

  • Patients presenting with low grade persistent fevers, even high fevers requiring admission to High Dependancy Unit for septicaemia.
  • Usually immune compromised patients: Diabetics, Corticosteroid users, Viral immune-deficiency states etc.
  • This condition requires urgent drainage.
  • The patients needs to be resuscitated first by an emergency team with appropriate fluids and antibiotics and placed in an area where all systems can be supported (HDU).
  • As soon as the patient is stable, this abcess needs to be drained, either with open surgery or percutaneous drain placement.
  • If it is a large pyonephrosis with a non-functioning kidney, a nephrectomy should be considered.

How is it done?

  • Patients will receive a general anaesthesia.
  • Appropriate resuscitation would have been started.
  • Prophylactic anti-biotics is given.
  • An indwelling catheter is placed.
  • The correct kidney is identified and marked while you are awake.
  • If it is a small abcess, an ultrasound guided needle is placed through your back or side into the fluid collection. A guidewire will be placed through the cannula and a drain fed in over the guidewire. All the puss will be drained.
  • If it is a large loculated abcess, an incision will be made over the area closest to the skin. The cavity will be opened, drained and rinsed, after which a drain will be placed.
  • If you have a non functioning kidney associated with this, your kidney may be removed at the same time. ( see open nephrectomy).
  • A drain is left post-operatively.

What next?

  • You will spend up to 7 or more nights in hospital.
  • You may be on life support depending on the degree of sepsis.
  • You will have intavenous fluids, antibiotics and circulatory supporting drugs being administered. Either a central venous line for monitoring, an arterial line and a peripheral infusion line.
  • You will have a catheter for that time.
  • A drain for 2-3 days.
  • Your drain will be removed with minimal drainage present.
  • You will a trial without the catheter as soon as you are back in the ward.
  • You will be discharged as soon as your renal function has stabilised and you have opened your bowels.
  • Allow for 6 weeks for stabilization of symptoms.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
  • Don’t hesitate to ask Jo if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Risks

  • This a potentially dangerous condition, which could result in death. It requires urgent management!
  • May loose your kidney in serious cases.
  • May risk Dialysis when in septic shock.
  • Wound Infection.
  • Prolonged stay in HDU.
  • Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
  • NB! Each person is unique and for this reason symptoms vary

Drainage Renal Abcess Drainage Renal Abcess (443 KB)