BACKGROUND: To characterise the clinical, microbiological, radiological and operative features of Xanthogranulomatous Pyelonephritis (XGP) in a 10-year retrospective case series from the Top End of the Northern Territory (NT) of Australia.

METHODS: We retrospectively reviewed all histopathologically confirmed XGP cases managed at Royal Darwin Hospital (2014-2024). Inclusion criteria were adults undergoing nephrectomy with a final histopathological diagnosis of XGP. Data included demographics, comorbidities, microbiology, imaging and surgical details. Descriptive analysis was performed.

RESULTS: Ten cases were identified, 90% were female and 70% identified as Aboriginal and/or Torres Strait Islander. Mean age was 43.5 years overall, but lower among Aboriginal and/or Torres Strait Islander patients at 39 years. Most resided in remote or very remote areas. Recurrent urinary tract infections and staghorn calculi occurred in 80% of cases. Escherichia coli was the most isolated organism. Three patients experienced delays to care due to discharge against medical advice or loss to follow-up; two had encrusted ureteric stents in situ for over 5 years. All patients underwent nephrectomy; one laparoscopic case was converted to open. Three procedures were elective. All patients required postoperative ICU admission. No deaths occurred, although one patient developed necrotising fasciitis in the wound.

CONCLUSION: This first Australian case series of XGP highlights an overrepresentation of Aboriginal and/or Torres Strait Islander patients. Findings align with global patterns in presentation and management, but underscore regional challenges including delayed care, advanced disease and surgical complexity in the context of chronic health inequities. Culturally safe and community-informed strategies are essential to improve outcomes in this high-risk population.