Cutaneous calicostomy for salvage urinary diversion

Area of Science:

• Neonatal surgery
• Pediatric nephrology
• Fungal infections in neonates

Background:

• Renal candidiasis can cause obstructive nephropathy in premature infants.
• Standard treatments like nephrostomy drainage and antifungal therapy may be insufficient.

Observation:

• A premature male infant (24 weeks gestation) presented with obstructive nephropathy due to renal candidiasis.
• Bilateral proximal collecting system obstructions complicated management, precluding ureterostomy or pyelostomy.

Findings:

• Bilateral cutaneous calicostomies were performed as a salvage urinary diversion technique.
• The procedure successfully diverted the urinary tract and eradicated fungal balls.
• Post-procedure imaging confirmed the success of the cutaneous calicostomies.

Implications:

• Cutaneous calicostomy is a viable surgical option for managing obstructive uropathy secondary to renal candidiasis in neonates.
• This technique is particularly useful when standard antifungal therapy and drainage are unsuccessful and collecting system obstruction is present.
• While the urinary diversion was successful, the infant ultimately succumbed to non-urologic sepsis.