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Invasive fungal bezoar requiring partial cystectomy
Debasish Sundi1, Kenneth Tseng, Jeffrey K Mullins
1James Buchanan Brady Urological Institute, Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21224, USA.
Urology
|November 29, 2011
Summary
Recurrent fungal bezoars after holmium laser ablation of the prostate (HOLAP) can be challenging to treat. Open partial cystectomy provided a definitive solution for an invasive bladder fungal ball.
Area of Science:
- Urology
- Mycology
- Surgical Treatment
Background:
- Benign prostatic hypertrophy (BPH) is a common condition in older men.
- Holmium laser ablation of the prostate (HOLAP) is a standard BPH treatment.
- Post-procedural complications, though rare, require careful management.
Observation:
- A 67-year-old man presented with voiding difficulties post-HOLAP.
- A significant candidal (fungal) ball was identified in the bladder.
- Initial endoscopic removal and medical therapy (fluconazole, amphotericin B) failed, with recurrence within two weeks.
Findings:
- Repeated endoscopic attempts, including ultrasonic lithotripsy and fulguration, were unsuccessful in eradicating the fungal bezoar.
- The fungal ball was invasive, necessitating a more aggressive surgical approach.
- Open partial cystectomy successfully removed the fungal bezoar.
Implications:
- This case highlights the potential for complex fungal bezoar formation after HOLAP.
- Recalcitrant or invasive fungal bezoars may require open surgical intervention.
- Effective management strategies for post-prostate ablation fungal complications are crucial.
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