Fungal bezoars of the renal collecting system caused by candida albicans: Exemplary presentation of diagnostics and therapy

Fungal infections of the urinary tract have been increasing in numbers in r ecent years, caused by numerous factors, of which the most frequent are dia betes mellitus, prolonged antibiotic therapy and indwelling catheters. Even rare opportunistic infections of the upper urinary tract caused by saproph ytic fungi are increasing. A peculiarity of infections with the Candida- an d Aspergillus types is the formation of fungus bezoars in the upper tract w hich may lead to obstruction and bacterial superinfection. We report a case of a female diabetic patient with all the typical diagnost ic and therapeutic implications of a fungal bezoar. Imaging modalities like ultrasound and intravenous pyelogram offer a variety of possible different ial diagnoses, so that determination of the correct diagnosis is often dela yed. Since introduction of helical CT, however, this can be avoided. When a tumor or a bezoar of the collecting system is suspected, ureterorenoscopy (URS) reveals the correct diagnosis and can obtain material for culture. Sm all bezoars can be removed by URS, large lesions should be extracted percut aneously. Antimycotics can be applied percutaneously for local irrigation a nd/or systemically. Treatment should be continued until all filling defects of the upper urinary tract are resolved and the urine culture is sterile.