Short Oral

Aim: Emphysematous pyelonephritis (EPN) is a severe kidney infection with high mortality.Percutaneous nephrostomy (PCN) is the classical drainage standard in EPN, and Huang-Tseng staging was derived largely from percutaneously drained cohorts.Double-J ureteral stenting (JJ stent) is a less-morbid alternative, but comparative evidence is limited to small singlecentre series and JJ is often withheld in advanced (Huang III or above) disease.We report the largest JJ-versus-PCN EPN cohort to date and the first severity-matched comparison confined to Huang III or above disease.Method: We analysed 382 EPN patients managed by drainage alone (JJ, n = 167; PCN, n = 215), excluding nephrectomy, antibiotic-only and combined cases.Baseline characteristics and outcomes were compared.Primary outcomes were in-hospital mortality, deferred nephrectomy and length of stay (LOS); secondary outcomes were 48-h deterioration.Results: PCN patients had more advanced disease (Huang III or above 51.2% vs. 32.9%,p < 0.001) at baseline.LOS was shorter with JJ (8 vs. 10 days, p = 0.018), but mortality (9.6% vs. 12.1%, p = 0.54) and deferred nephrectomy (12.6% vs. 19.1%,p = 0.12) did not differ.In the Huang III or above subgroup (n = 165), no outcome differed significantly: mortality 14.5% versus 20.9% (p = 0.44), deferred nephrectomy 20.0% versus 30.0%(p = 0.24), LOS both 8 days (p = 0.89).Conclusion: JJ stenting achieved outcomes comparable to PCN, extending to advanced Huang III or above disease.This study suggests JJ stenting is a reasonable drainage option when compared to PCN in selected EPN patients.