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Xanthogranulomatous pyelonephritis: a review and meta-analysis with a focus on management

  • Urology - Review
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Abstract

Purpose

Xanthogranulomatous pyelonephritis (XGP) is a rare form of pyelonephritis more commonly seen in females and diabetics. Frequently associated with renal tract calculi, it is often difficult to diagnose, as it can clinically and radiologically mimic other disorders. Most cases are treated with antibiotics and nephrectomy. The aim of our review is to summarise and analyse the current evidence focusing on management.

Methods

A literature search was conducted to identify papers relating to xanthogranulomatous pyelonephritis in adults. Studies containing ten or more patients with XGP were included for descriptive analysis, and a meta-analyses of cohort studies conducted comparing open and minimally invasive nephrectomy undertaken. Other papers were included for narrative review.

Results

52 studies were identified, 20 were included for narrative review and 32 retrospective observational studies containing 868 patients were included for descriptive analysis. 99.8% of patients underwent nephrectomy, about one-third laparoscopically. The most commonly cultured organisms were Escherichia coli and Proteus mirabilis. 60% of patients, where reported, underwent preoperative drainage. Seven studies containing 211 patients were included for meta-analysis which found that postoperative complications, length of stay and transfusion requirements were all significantly reduced in those who underwent minimally invasive surgery.

Conclusion

The mainstay management of XGP is antibiotic therapy and nephrectomy. Some studies highlight a role for preoperative upper urinary tract drainage, but evidence supporting this is limited. We present the first meta-analyses examining operative approach for patients undergoing nephrectomy for XGP. Though limited by the data available, our meta-analysis indicates minimally invasive nephrectomy for XGP provides better postoperative outcomes.

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Abbreviations

XGP:

Xanthogranulomatous pyelonephritis

PCN:

Percutaneous nephrostomy

RCTs:

Randomised control trials

PRISMA:

Preferred Reporting Items in Systematic Reviews and Meta-Analyses

ON:

Open nephrectomy

LN:

Laparoscopic nephrectomy

MIS:

Minimally invasive surgery

RR:

Risk ratio

MD:

Mean difference

EAU:

European Association of Urology

AUA:

American Urological Association

IRD:

Inflammatory renal disease

ROBINS-I:

Risk of Bias in Non-randomized Studies-of interventions

M&E:

Malek and Elder

HAL:

Hand-assisted laparoscopy

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Author notes

  1. Paul Gravestock, Lauren Moore are the joint first authors.

Authors and Affiliations

  1. Urology Department, Freeman Hospital, Newcastle Upon Tyne, UK

    Paul Gravestock, Lauren Moore, Chris Harding & Rajan Veeratterapillay

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  1. Paul Gravestock
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  2. Lauren Moore
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Correspondence to Rajan Veeratterapillay.

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Gravestock, P., Moore, L., Harding, C. et al. Xanthogranulomatous pyelonephritis: a review and meta-analysis with a focus on management. Int Urol Nephrol 54, 2445–2456 (2022). https://doi.org/10.1007/s11255-022-03253-x

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