Successful Endoscopic Management of a Renal Fungal Ball using Flexible Ureterorenoscopy
Mahmoud Abuelnaga1, Sadegh Khoshzaban1, Mahmoud Reda Badr2
1Department of Urology, Bedford Hospital NHS Trust, Bedford, UK.
Background:
Candida as a cause for urinary tract infection in healthy individuals is unusual. The extension of fungi into the urinary collecting system rarely leads to formation of bezoars or fungus balls. This can in turn lead to hydronephrosis, obstructive uropathy and sepsis.
Case Presentation:
An eighty years old gentleman presented to A&E with confusion, severe urosepsis and acute kidney injury. CTKUB demonstrated significant right sided hydronephrosis, perinephric fat stranding and gas in collecting system. A year prior to this admission he has become known to the urology team for a fungal ball that was noted in the upper pole of the right kidney which was picked up following elective flexible ureterorenoscopy for right kidney stones. Flexible ureterorenoscopy and successful retrieval of fungal ball by basket was performed.
Conclusion:
We advocate this technique to be considered as an alternative to the current treatment offered to patients with fungal ball infections and especially so in cases were a nephrostomy is either contraindicated, unavailable, or not possible.
Insights
Fungal balls in the urinary tract are rare but can cause serious complications. Flexible ureterorenoscopy offers a minimally invasive option for fungal ball removal, especially when other treatments are not feasible.
Area of Science:
- Urology
- Infectious Diseases
- Nephrology
Background:
- Fungal urinary tract infections (UTIs) are uncommon in healthy individuals.
- Fungal bezoars (fungus balls) in the urinary collecting system can lead to severe complications like hydronephrosis, obstructive uropathy, and sepsis.
- This case highlights a rare presentation of a fungal ball causing obstructive uropathy.
Observation:
- An 80-year-old male presented with confusion, severe urosepsis, and acute kidney injury.
- CT KUB revealed right-sided hydronephrosis, perinephric fat stranding, and gas within the collecting system.
- A year prior, the patient had a known fungal ball in the right kidney, identified during evaluation for kidney stones.
Findings:
- Flexible ureterorenoscopy was performed for the retrieval of the fungal ball.
- Successful retrieval of the fungal ball using a basket was achieved.
- This intervention addressed the obstructive uropathy and sepsis.
Implications:
- Flexible ureterorenoscopy is a viable alternative treatment for urinary tract fungal balls.
- This technique is particularly useful when nephrostomy is contraindicated, unavailable, or not possible.
- Minimally invasive endoscopic removal of fungal balls can prevent severe renal complications.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:28Urologic Endoscopic Procedure: Cystoscopic Examination
01:26Kidney Transplant II: Surgical Procedure
01:30Urinary Tract Calculi III: Medical Management