Clinical characteristics and treatment strategies of patients with fungal infections in the treatment of upper urinary tract calculi / 中华泌尿外科杂志

ABSTRACT

Objective:To discuss the clinical management, such as characteristics, surgical timing and rational application of antifungal drugs in patients of upper urinary calculi with fungal infections.Methods:A retrospective analysis was performed on 4 patients with fungal infections during the treatment of upper urinary calculi from April 2017 to April 2019. Case 1, male, 55 years old, was admitted to the Department of Nephrology due to febrile urinary tract infection. Right ureteral stone was found during antibacterial treatment. Fever and fungal sepsis occurred after transurethral ureteroscopic lithotripsy. Case 2 Female, 48 years old, frequency and urgency occurred after percutaneous nephrolithotomy of right kidney in another hospital. Urine routine WBCs were full of vision, urine culture was Candida albicans, symptoms disappeared after 2 weeks of oral fluconazole 200 mg QD treatment, urine culture turned negative, discontinued fluconazole symptoms recurred in about 2-4 weeks and the urine culture turned positive, the condition was repeatedly for 1 year. The CT showed multiple small stones in both kidneys. Case 3 Male, 74 years old, frequency, urgency, and dysuria occurred after flexible ureteroscopic holmium laser lithotripsy of left kidney. Urine routine WBCs were full of vision, urine culture was Candida albicans. Symptoms slightly after 2 weeks of oral fluconazole 200 mg QD treatment according to drug sensitivity, but urine culture did not turn negative, discontinued fluconazole symptoms increased. The condition was lasted for one and a half years. His CT showed left kidney lower calyx stones. Case 4 male, 47 years old, frequency, urgency, and dysuria occurred after the surgery of left kidney stone for half a year. Urine routine WBCs were full of vision, urine culture was Candida tropicalis, combined with left kidney cast stones.Results:Case 1, male, 55 years old, was admitted to the Department of Nephrology due to febrile urinary tract infection. Right ureteral stone was found during antibacterial treatment. Fever and fungal sepsis occurred after transurethral ureteroscopic lithotripsy. Case 2 patient was performed bilateral ureteral stent placement for drainage, and two weeks after the oral fluconazole 200 mg QD, she was performed bilateral flexible ureteroscopic lithotripsy, then the urinary fungal infection was cured. Case 3 patient was performed left side ureteral stent placement and amphotericin B and fluconazole antifungal therapy. After his body temperature was normal, he was performed flexible ureteroscopic holmium laser lithotripsy, after the surgery the oral fluconazole 200 mg QD time was just 1 week, resulting in the formation of fungal balls in the left renal pelvis and secondary surgery. Oral fluconazole 200 mg QD combined with fluconazole continuous intraperitoneal perfusion ultimately 1 week cured him after and secondary surgery. Case 4 patient was performed percutaneous nephrostomy drainage and oral fluconazole 200 mg QD for 2 weeks. Then he was performed percutaneous nephrolithotomy lithotripsy, oral fluconazole 200 mg QD was continued until the stent was removed and urine culture turned negative, patient was cured. Case 4 patient had fungal bloodstream infection after ureteroscopic holmium laser lithotripsy. The temperature was normal after intravenous drip of fluconazole 200 mg QD antifungal therapy, and fungal endophthalmitis occurred in ophthalmology 1 week after discharge.Conclusions:Diabetes could be a high risk factor for upper urinary calculi complicated with fungal infection. It is difficult to control the fungal infection without stone removed and it is easy to relapse after surgery. Stones should be removed on the basis of antifungal therapy, and antifungal therapy should be continued after surgery at least 2 weeks after urinary stent removal. If fungal bloodstream infections is diagnosed, eye examination should be done to screen for endophthalmitis to determine if there is tissue dissemination and determine the course of treatment.