Skip to main content

Advertisement

SpringerLink
Log in

Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy.

Methods

A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed.

Results

A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications.

Conclusion

Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Data supporting Tables 1–5 and Supplementary Tables are not publicly available in order to protect patient privacy.

References

  1. Harley F, Wei G, O’Callaghan M, Wong LM, Hennessey D, Kinnear N (2022) Xanthogranulomatous pyelonephritis: a systematic review of treatment and mortality in more than 1000 cases. BJU Int. https://doi.org/10.1111/bju.15878

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rosoff JS, Raman JD, Del Pizzo JJ (2006) Feasibility of laparoscopic approach in management of xanthogranulomatous pyelonephritis. Urology 68:711–714. https://doi.org/10.1016/j.urology.2006.04.031

    Article  PubMed  Google Scholar 

  3. Arvind NK, Singh O, Ali Q, Gupta SS, Sahay S (2011) Laparoscopic nephrectomy in xanthogranulomatous pyelonephritis: 7-year single-surgeon outcome. Urology 78:797–801. https://doi.org/10.1016/j.urology.2011.05.062

    Article  PubMed  Google Scholar 

  4. Vanderbrink BA, Ost MC, Rastinehad A et al (2007) Laparoscopic versus open radical nephrectomy for xanthogranulomatous pyelonephritis: Contemporary outcomes analysis. J Endourol 21:65–70. https://doi.org/10.1089/end.2006.0188

    Article  PubMed  Google Scholar 

  5. Bercowsky E, Shalhav AL, Portis A, Elbahnasy AM, McDougall EM, Clayman RV (1999) Is the laparoscopic approach justified in patients with xanthogranulomatous pyelonephritis? Urology 54:437–442. https://doi.org/10.1016/s0090-4295(99)00261-7

    Article  CAS  PubMed  Google Scholar 

  6. Singer M, Deutschman CS, Seymour CW et al (2016) The Third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810. https://doi.org/10.1001/jama.2016.0287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Malek RS, Elder JS (1978) Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature. J Urol 119(5):589–593. https://doi.org/10.1016/s0022-5347(17)57559-x

    Article  CAS  PubMed  Google Scholar 

  8. Hsueh PR, Ko WC, Wu JJ et al (2010) Consensus statement on the adherence to Clinical and Laboratory Standards Institute (CLSI) Antimicrobial Susceptibility Testing Guidelines (CLSI-2010 and CLSI-2010-update) for Enterobacteriaceae in clinical microbiology laboratories in Taiwan. J Microbiol Inmunol Infect 43(5):452–455. https://doi.org/10.1016/S1684-1182(10)60070-9

    Article  Google Scholar 

  9. Trujillo-Santamaría H, Robles-Torres JI, Teoh JYC et al (2022) A novel mortality risk score for emphysematous pyelonephritis: a multicenter study of the Global Research in the Emphysematous Pyelonephritis group. Curr Urol. https://doi.org/10.1097/CU9.0000000000000163

    Article  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  11. Oberling C (1935) Retroperitonealxanthogranuloma. Am J Cancer 23:477–489

    Article  Google Scholar 

  12. Parker MD, Clark RL (1989) Evolving concepts in the diagnosis of xanthogranulomatous pyelonephritis. Urol Radiol 11(1):7–15. https://doi.org/10.1007/bf02926465

    Article  CAS  PubMed  Google Scholar 

  13. Udare A, Abreu-Gomez J, Krishna S, McInnes M, Siegelman E, Schieda N (2019) Imaging manifestations of acute and chronic renal infection that mimics malignancy: how to make the diagnosis using computed tomography and magnetic resonance imaging. Can Assoc Radiol J 70(4):424–433. https://doi.org/10.1016/j.carj.2019.07.002

    Article  PubMed  Google Scholar 

  14. Zugor V, Schott GE, Labanaris AP (2007) Xanthogranulomatous pyelonephritis in childhood: a critical analysis of 10 cases and of the literature. Urology 70(1):157–160. https://doi.org/10.1016/j.urology.2007.02.068

    Article  PubMed  Google Scholar 

  15. Bingöl-Koloğlu M, Ciftçi AO, Senocak ME, Tanyel FC, Karnak I, Büyükpamukçu N (2002) Xanthogranulomatous pyelonephritis in children: diagnostic and therapeutic aspects. Eur J Pediatr Surg 12(1):42–48. https://doi.org/10.1055/s-2002-25085

    Article  PubMed  Google Scholar 

  16. Partin AW, Wein AJ, Kavoussi LR, Peters CA (2020). Dmochowski R. Campell Walsh Wein Urology. Elsevier Saunders, Philadelphia

  17. Ripa F, Pietropaolo A, Montanari E, Hameed BMZ, Gauhar V, Somani BK (2022) Association of kidney stones and recurrent UTIs: the Chicken and Egg Situation. A systematic review of literature. Curr Urol Rep 23(9):165–174. https://doi.org/10.1007/s11934-022-01103-y

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rachidi SA, Zeriouel A (2018) Renal tumor or pseudotumoral xanthogranulomatous pyelonephritis. Pan Afr Med J 29:67. https://doi.org/10.11604/pamj.2018.29.67.14611

  19. Craig WD, Wagner BJ, Travis MD (2008) Pyelonephritis: radiologic-pathologic review. Radiographics 28(1):255–277. https://doi.org/10.1148/rg.281075171

    Article  PubMed  Google Scholar 

  20. Gaillard F, El-Feky M (2022). Xanthogranulomatous pyelonephritis. Radiopaedia.org publishing. https://doi.org/10.53347/rID-9944. Accessed on 29 Sep 2022

  21. Goldman SM, Hartman DS, Fishman EK, Finizio JP, Gatewood OM, Siegelman SS (1984) CT of xanthogranulomatous pyelonephritis: radiologic-pathologic correlation. Am J Roentgenol 142(5):963–969. https://doi.org/10.2214/ajr.142.5.963

    Article  CAS  Google Scholar 

  22. Deem SG, Mobley JD (2021) Xanthogranulomatous Pyelonephritis. Medscape Publishing. https://emedicine.medscape.com/article/2050430-overview. Accessed on August 2021

  23. Shah KJ, Ganpule AP, Kurien A, Muthu V, Sabnis RB, Desai MR (2011) Laparoscopic versus open nephrectomy for xanthogranulomatous pyelonephritis: an outcome analysis. Indian J Urol 27:470–474. https://doi.org/10.4103/0970-1591.91434

    Article  PubMed  PubMed Central  Google Scholar 

  24. Asali M, Tsivian A (2019) Laparoscopic nephrectomy in xanthogranulomatous pyelonephritis. Cent Eur J Urol 72(3):319–323. https://doi.org/10.5173/ceju.2019.1891

    Article  Google Scholar 

  25. Hemal AK, Gupta NP, Wadhwa SN, Goel A, Kumar R (2001) Retroperitoneoscopic nephrectomy and nephroureterectomy for benign nonfunctioning kidneys: a single-center experience. Urology 57:644–649. https://doi.org/10.1016/s0090-4295(00)01059-1

    Article  CAS  PubMed  Google Scholar 

  26. Addison B, Zargar H, Lilic N, Merrilees D, Rice M (2015) Analysis of 35 cases of Xanthogranulomatous pyelonephritis. ANZ J Surg 85(3):150–153. https://doi.org/10.1111/ans.12581

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital Universitario “Dr. José Eleuterio, González”, Monterrey, Nuevo León, Mexico

    José Iván Robles-Torres, Luis Roberto García-Chairez, Joana Valeria Enrriquez-Ávila & Adrián Gutiérrez-González

  2. Urology Unit Azienda Ospedaliero–Universitaria Delle Marche, Ancona, Italy

    Daniele Castellani

  3. Hospital Regional de Alta Especialidad de La Penisula de Yucatán, Mérida, Mexico

    Juan Francisco Monzón-Falconi, Antonio Esqueda-Mendoza & Juan Pablo Flores-Tapia

  4. Faculdade de Medicina Do ABC, Santo André, São Paulo, SP, Brazil

    Marcelo Langer Wroclawski

  5. BP – a Beneficência Postuguesa de São Paulo, São Paulo, SP, Brazil

    Marcelo Langer Wroclawski

  6. Hospital Municipal Moysés Deutsch, São Paulo, SP, Brazil

    Hugo Octaviano Duarte-Santos

  7. Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India

    Deepak Ragoori

  8. Saint Petersburg State University Hospital, St. Petersburg, Russia

    Nariman Gadzhiev

  9. Mahatma Gandhi Mission’s Medical College and Hospital, Aurangabad, India

    Abhay Mahajan

  10. Department Urology, Christian Medical College, Vellore, Tamil Nadu, India

    Santosh Kumar & Mudasir Farooq

  11. Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India

    Arvind Ganpule

  12. Department of Urology, Marmara University School of Medicine, Istanbul, Turkey

    Yiloren Tanidir

  13. Fortis Hospital Mulund, Mumbai, India

    Pankaj Nandkishore Maheshwari

  14. Grant Medical College and Sir JJ Hospital, Mumbai, India

    Venkat Arjunrao Gite

  15. University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK

    Mriganka Mani Sinha & Bhaskar K. Somani

  16. Ng Teng Fong General Hospital (NTFGH)/NUHS, Singapore, Singapore

    Vineet Gauhar

Authors
  1. José Iván Robles-Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luis Roberto García-Chairez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniele Castellani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joana Valeria Enrriquez-Ávila
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Francisco Monzón-Falconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Esqueda-Mendoza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Juan Pablo Flores-Tapia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marcelo Langer Wroclawski
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hugo Octaviano Duarte-Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Deepak Ragoori
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nariman Gadzhiev
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Abhay Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Santosh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Mudasir Farooq
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Arvind Ganpule
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yiloren Tanidir
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Pankaj Nandkishore Maheshwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Venkat Arjunrao Gite
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Mriganka Mani Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Bhaskar K. Somani
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Adrián Gutiérrez-González
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Vineet Gauhar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JI Robles-Torres: protocol/project development, data analysis, manuscript writing/editing, data analysis; LR García-Chairez: protocol/project development, data collection or management; D Castellani: protocol/project development, data analysis, manuscript writing/editing; JV Enrriquez-Ávila: data collection or management; JF Monzón-Falconi: data collection or management, manuscript writing/editing; A Esqueda-Mendoza: data collection or management; JP Flores-Tapia: data collection or management; ML Wroclawski: data collection or management, manuscript writing/editing; HO Duarte-Santos: data collection or management; D Ragoori: data collection or management, manuscript writing/editing; N Gadzhiev: data collection or management, manuscript writing/editing; A Mahajan: data collection or management; S Kumar: data collection or management, manuscript writing/editing; M Farooq: Data collection or management; A Ganpule: Data collection or management; Y Tanidir: Data collection or management, Manuscript writing/editing; PN Maheshwari: data collection or management; VA Gite: data collection or management, manuscript writing/editing; MM Sinha: data collection or management; BK Somani: data collection or management, manuscript writing/editing; A Gutiérrez-González: protocol/project development, manuscript editing; V Gauhar: protocol/project development, Data analysis, Manuscript writing/editing.

Corresponding author

Correspondence to José Iván Robles-Torres.

Ethics declarations

Conflict of interest

None of the authors have a conflict of interest or funding source to declare.

Research involving human participants and/or animals

This retrospective study involving human participants was in accordance with the ethical standards of the institutional research committee of each center involved and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee of each center was obtained for this study.

Informed consent

The study is exempt from the application of informed consent to the study subjects.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 38 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Robles-Torres, J.I., García-Chairez, L.R., Castellani, D. et al. Perioperative outcomes and risk factors for major complications associated with nephrectomy for Xanthogranulomatous pyelonephritis: a multicenter study. World J Urol 41, 2905–2914 (2023). https://doi.org/10.1007/s00345-023-04415-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-023-04415-x

Keywords

Search

Navigation