Pyelonephritis is usually managed medically. In recurrent infections, additional investigations may identify an underlying abnormality like a stone, a tumor, or an underlying pathological process that has to be aggressively dealt with. Surgery is usually indicated in a patient who does not improve after 48 hours of IV antibiotics or deteriorates. Occasionally, surgical intervention is necessary to decrease of recurrence and to prevent devastating complications. Various renal conditions like obstructive pyelonephritis with presence of stones in the presence of an infected kidney can be fatal and requires urgent management.

Surgery may be necessary in case of:

• No improvement after 48 hours of IV antibiotics
• Continuous deteriorating pyelonephritis
• Recurrence
• Devastating complications

The following kinds of surgeries can be associated with the management of pyelonephritis:^{[1][2][3][4][5]}

• A partial nephrectomy is performed in case of a localised renal pathology. It can also be done in case of low grade real disease that is resistant to medical management.
• Partial Nephrectomy involves excising only the involved segment of the kidney leaving behind the healthy part of the kidney.

• Nephrectomy is considered in case the renal involvement is diffuse or the damage to the kidney is in an advanced stage.
• Nephrectomy may also be required in cases of severe complications.

Emphysematous pyelonephritis can be treated with a vacuum sealing drainage. A vacuum sealing drainage (VSD) sponge is tailored and placed around the kidney ensuring no dead space is present. A negative low pressure helps drain the pus and the gas present in case of emphysematous pyelonephritis.^[6]