Drainage Renal Abscess

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

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Drainage renal abscess