使用软性输尿管肾镜成功内镜治疗肾真菌球
Successful Endoscopic Management of a Renal Fungal Ball using Flexible Ureterorenoscopy.
作者信息
Abuelnaga Mahmoud, Khoshzaban Sadegh, Reda Badr Mahmoud, Chaudry Aasem
机构信息
Department of Urology, Bedford Hospital NHS Trust, Bedford, UK.
Department of Urology, Ain Shams University Hospitals, Cairo, Egypt.
出版信息
Case Rep Urol. 2019 Dec 17;2019:9241928. doi: 10.1155/2019/9241928. eCollection 2019.
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.
背景
念珠菌作为健康个体尿路感染的病因并不常见。真菌蔓延至尿液收集系统很少会导致形成粪石或真菌球。这进而可能导致肾积水、梗阻性尿路病和败血症。
病例报告
一名80岁男性因意识模糊、严重尿脓毒症和急性肾损伤就诊于急症室。CT尿路造影（CTKUB）显示右侧严重肾积水、肾周脂肪条索状改变以及收集系统内有气体。此次入院前一年，泌尿外科团队发现其右肾上极有一个真菌球，该真菌球是在因右肾结石行选择性软性输尿管肾镜检查时发现的。遂行软性输尿管肾镜检查并用网篮成功取出真菌球。
结论
我们主张将该技术视为真菌球感染患者当前治疗方法的替代方案，尤其是在肾造瘘术禁忌、无法实施或不可行的情况下。
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