Drainage instead of open surgery
Under ultrasound guidance, the abscess is punctured with a needle, the contents are sent for culture, drainage with a curl of 3–4 mm in diameter is installed along the guidewire, and the cavity is washed with an antiseptic. The drainage is washed daily, the volume of discharge decreases as sanitization proceeds; after 5–10 days, if the cavity has collapsed according to ultrasound, the drainage is removed. In parallel, intravenous antibacterial therapy is carried out by culture and obstruction of the urinary tract (stent, nephrostomy) is eliminated. An open autopsy is required only in case of multiple foci, purulent melting of the kidney or ineffective drainage - then nephrectomy is discussed.
Abscesses in urology
Purulent foci in urological practice occur against the background of urinary tract infection, obstruction, diabetes mellitus, after manipulation: prostate abscess as a complication of prostatitis, abscess of the perineum and scrotum, groin boils, abscess and paranephritis of the kidney with pyelonephritis. Signs are increasing throbbing pain, temperature with chills, thickening and redness, and with prostate abscess - urinary retention and pain during defecation. The formed abscess does not resolve with antibiotics and requires opening or drainage.
After opening
The cavity is drained until the purulent discharge stops (2–7 days), daily dressings and rinsing are performed, and the antibiotic is selected based on culture. The wound heals by secondary intention in 1–3 weeks. It is imperative to eliminate the cause: correction of diabetes, treatment of urinary tract infections, and in case of obstruction, drainage of the urinary tract. Control ultrasound confirms the disappearance of the cavity.
