[Pyeloureteral fungus ball in patients with urinary lithiasis. Treatment with ureterorenoscopy]
J P Burgués Gasión1, J M Alapont Alacreu, F Oliver Amorós
1Servicio de Urología, Hospital Universitario La Fe, Valencia.
Introduction:
C. albicans is the most frequent fungus causing opportunist infections of the urinary tract. Agglutination of necrotic tissue nucleus (papilary necrosis), mucosus debri and chirurgic or lithiasic debri, originates a fungus ball, which can obstruct the urinary tract at any level.
Clinical Data:
We present 2 patients with obstructive urinary lithiasis developing fungus ball in the dilated upper urinary tract. Patient 1 was bilaterally affected and never had systemic symptoms. Treatment consisted of uretherorrenoscope for removal of fungus ball, bilateral urinary diversion and anphotericine B irrigations and systemic. Patient 2 developed a candidemia and was treated with systemic liposomal anphotericine B, uretherorrenoscopy with removal of ureteric calculus and fungus ball, and placement of a double J catheter and nephrostomy tube for anphotericine B irrigation.
Discussion:
Urinary lithiasis is a risk factor for fungal infection of the upper urinary tract, provided there is no other predisponent factor for opportunistic fungal infections. Calculi facilitates fungal growth by means of obstruction and subsequent retrograde estasis and creating a nucleus for growth, aggregation and ramification of mycelium. The infection pathway is probably ascendent and may turn into fungemia and septicaemia. Systemic antimicotics, urinary diversion and local irrigations with antimicotics, and endourologic technics, are the three basic items in the treatment. Ureterorrenoscopy plays an important roll as a diagnostic and therapeutic tool as it may solve the obstruction and allows removal of fungus ball.
Insights
Urinary stones can lead to fungal infections, forming obstructive fungus balls in the urinary tract. Early diagnosis and treatment involving antifungal medications and endoscopic procedures are crucial for managing these severe infections.
Area of Science:
- Urology
- Mycology
- Infectious Diseases
Background:
- Candida albicans is a common cause of opportunistic urinary tract infections.
- Fungal balls can form from debris, obstructing the urinary tract.
- Urinary lithiasis (stones) is identified as a risk factor for fungal urinary tract infections.
Observation:
- Two cases of obstructive urinary lithiasis with fungal ball formation in the upper urinary tract are presented.
- Patient 1 had bilateral involvement without systemic symptoms; treated with ureterorenoscopy, diversion, and amphotericin B.
- Patient 2 developed candidemia and was treated with systemic liposomal amphotericin B, ureterorenoscopy, and supportive urinary drainage with irrigation.
Findings:
- Urinary calculi facilitate fungal growth by causing obstruction, stasis, and providing a nucleus for fungal aggregation.
- Ascending infection can lead to fungemia and sepsis.
- Ureterorenoscopy is a valuable diagnostic and therapeutic tool for removing fungus balls and relieving obstruction.
Implications:
- Prompt diagnosis and intervention are critical for preventing complications like sepsis.
- Integrated treatment strategies combining systemic antifungals, urinary diversion, local irrigation, and endourologic techniques are essential.
- Recognizing urinary lithiasis as a risk factor can improve early detection of fungal urinary tract infections.
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