Tan Wei Phin, Turba Ulku C, Deane Leslie A
Department of Urology, Rush University Medical Center, Chicago, Illinois - USA.
Department of Radiology, Rush University Medical Center, Chicago, Illinois - USA.
Urologia. 2017 Apr 28;84(2):113-115. doi: 10.5301/uro.5000201. Epub 2016 Oct 15.
We describe a case of renal pelvi-ureteric fungus ball managed with placement of two nephrostomy tubes and amphotericin B irrigation through a nephrostomy tube with the other to free drain.
A 46-year-old man with uncontrolled Type 2 diabetes mellitus was referred to the urology clinic for workup of recurrent urinary tract infection. Urine culture grew Candida albicans. The patient was started on oral fluconazole therapy. Cystoscopy and cystogram revealed a grade 3 left vesicoureteral reflux and right retrograde pyelogram revealed a filling defect in the right renal pelvis extending into the proximal ureter with severe hydroureteronephrosis. Two nephrostomy tubes were placed (mid-pole and lower pole) to ensure that the system was not obstructed. Amphotericin B (50 mg/1000 ml normal saline) irrigation was then instilled through the mid-pole nephrostomy tube at a rate of 30 ml/h with the lower pole nephrostomy tube to free drain. An antegrade nephrostogram was performed after 5 days of amphotericin B instillation, showing complete resolution of the fungus ball. The patient is awaiting definitive minimally invasive management of the distal ureteral narrowing.
Renal and pelvi-ureteric fungus ball is a challenging clinical entity. It must be addressed promptly and efficiently to be successful. We describe a minimally invasive approach that was tolerated well and resulted in complete clearance of the fungus ball in a relatively short time frame.
我们描述了一例肾盂输尿管真菌球病例，通过置入两根肾造瘘管并经一根肾造瘘管灌注两性霉素B，另一根肾造瘘管用于自由引流来进行治疗。
一名46岁2型糖尿病控制不佳的男性因反复尿路感染被转诊至泌尿外科门诊。尿培养结果为白色念珠菌生长。患者开始接受口服氟康唑治疗。膀胱镜检查和膀胱造影显示左侧膀胱输尿管反流3级，右侧逆行肾盂造影显示右肾盂内充盈缺损延伸至近端输尿管，并伴有严重的肾输尿管积水。置入两根肾造瘘管（中极和下极）以确保泌尿系统无梗阻。然后通过中极肾造瘘管以30 ml/h的速度灌注两性霉素B（50 mg/1000 ml生理盐水），下极肾造瘘管用于自由引流。两性霉素B灌注5天后进行顺行肾造影，显示真菌球完全消失。患者正在等待对远端输尿管狭窄进行确定性的微创治疗。
肾及肾盂输尿管真菌球是一种具有挑战性的临床病症。必须迅速且有效地处理才能取得成功。我们描述了一种微创方法，该方法耐受性良好，并在相对较短的时间内使真菌球完全清除。
