Management of Xanthogranulomatous Pyelonephritis: A Review of Current Evidence and Treatment Strategies and a Proposed Clinical Management Algorithm.

Xanthogranulomatous pyelonephritis is an uncommon destructive inflammatory process of the renal parenchyma associated with urinary tract obstruction and infection. Preoperative diagnosis remains challenging with correct identification in less than half of cases. Management paradigms include immediate surgical intervention or staged approaches that emphasize preoperative optimization and percutaneous drainage. Radical nephrectomy remains the de facto definitive treatment though critical evidence gaps underscore the need for more rigorous study to guide management.