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Percutaneous nephrostomy for nonoperative management of fungal urinary tract infections
D A Bell1, S C Rose, N K Starr
1Department of Radiology, University of Utah School of Medicine, Salt Lake City.
Purpose:
Percutaneous nephrostomy has proved to be an important modality in the nonoperative treatment of bacterial pyonephrosis. The role of this technique in the management of fungal pyonephrosis continues to evolve. The authors retrospectively reviewed their experience with percutaneous nephrostomy in the management of fungal pyonephrosis.
Patients And Methods:
Seven patients, two neonates and five adults, were identified with proved fungal infections. Eleven percutaneous nephrostomy tubes were placed, all with use of the Seldinger technique.
Results:
Percutaneous nephrostomy allowed (a) prompt microbiologic diagnosis of fungal infection (Candida albicans in six patients, Torulopsis glabrata in one); (b) urinary diversion with subsequent improvement in renal function, enabling systemic administration of potentially toxic antifungal drugs 5-fluorocytosine and amphotericin B (four patients); (c) local irrigation with amphotericin B (four patients), (d) guidewire fragmentation of fungus balls (two patients); and (e) introduction of a Simpson atherectomy device to obtain biopsy specimens from an obstructing ureteral polypoid lesion (one patient). The funguria was successfully eradicated in six patients, one of whom died on the 39th hospital day of a pulmonary embolus and another of whom died of extensive small bowel infarction during hospitalization. The one patient whose outcome of antifungal treatment remains unknown died at home with a functioning percutaneous nephrostomy 23 days after the procedure.
Conclusion:
Percutaneous nephrostomy may play a role in the non-operative management of fungal urinary tract infection.
Insights
Percutaneous nephrostomy aids in diagnosing and managing fungal pyonephrosis. This minimally invasive procedure facilitated treatment and improved renal function in most patients with fungal urinary tract infections.
Area of Science:
- Urology
- Infectious Diseases
- Nephrology
Background:
- Bacterial pyonephrosis is effectively managed non-operatively with percutaneous nephrostomy.
- The role of percutaneous nephrostomy in fungal pyonephrosis is still evolving.
Purpose of the Study:
- To review the experience with percutaneous nephrostomy in managing fungal pyonephrosis.
Main Methods:
- Retrospective review of seven patients (two neonates, five adults) with proven fungal infections.
- Eleven percutaneous nephrostomy tubes were placed using the Seldinger technique.
Main Results:
- Percutaneous nephrostomy enabled prompt diagnosis of fungal infection (Candida albicans, Torulopsis glabrata).
- It facilitated urinary diversion, improved renal function, and allowed systemic/local antifungal drug administration.
- Successful eradication of funguria was achieved in six patients.
Conclusions:
- Percutaneous nephrostomy can be a valuable tool in the non-operative management of fungal urinary tract infections.