Fungal Balls Mimicking Renal Calculi: A Zebra Among Horses

Unilateral renal fungus ball caused by Candida glabrata

A 46-year-old diabetic woman with unilateral renal fungus ball was successfully treated with antifungal therapy, endoscopic extraction and ureteral stent placement. The patient was initially treated for a right staghorn calculus, thereafter developed urinary symptoms. Imaging revealed distal left ureter filling defects and a previous stent at the ureteropelvic junction. Urine culture confirmed Candida glabrata sensitive to Micafungin. Bilateral ureteroscopy facilitated the extraction of a left renal pelvis fungus ball. This case underscores the challenges in diagnosing fungal UTIs in patients with predisposing factors, and highlights a combined medical and surgical approach for effective treatment of renal fungus balls.

Vesical fungal bezoars on post-TURBT scar tissue causing obstruction and mimicking urothelial carcinoma

Fungal bezoars (fungal balls) are rarely reported in the upper or lower urinary tract. They can be the cause of severe morbidities such as urinary tract obstruction, renal failure and fungaemia. Hereby, we present a rare case of a male patient who underwent transurethral resection of bladder tumour (TURBT), and during his postoperative period, he was diagnosed with bladder fungal bezoars adherent to his resection area. The fungal bezoars were covering an extended area of the right lateral bladder wall, including the right ureteric orifice and causing right urinary tract obstruction. Those findings were manifested only after a relooked cystoscopy and histological evaluation.We aim to present a rare example of fungal bezoars mimicking other pathologies in the urinary tract and review the current literature for similar documentation. We underline the necessity of follow-up examinations for urologists performing TURBT surgeries, including urinalysis, imaging modalities and cystoscopy.

Extensive Urinary Tract Fungal Bezoars Causing Anuria: A Case Report

Fungal bezoar formation is a complication of fungal urinary tract infections that are usually caused by Candida species and other fungal types. They can form in any site along the urinary tract and may cause an obstruction to the urine flow that would require drainage by nephrostomy, a ureteric stent, and sometimes surgical intervention is needed. In this case report we discuss a case of an adult male who had an extensive fungal bezoar infection caused by Candida tropicalis causing him anuria and acute kidney injury. The bezoars were found in the bladder, the ureters, and both kidneys. The patient was treated with bilateral ureteric stent insertion and with fluconazole for 3 weeks. Bilateral ureteroscopy and urine culture were done after 2 months and they showed that the bezoars have been eradicated on both gross and microscopic levels.

A case of ureteral fungal mass removal in a patient taking empagliflozin

With increased use of sodium-glucose co-transporter 2 (SGLT2) inhibitors as antidiabetic agents, the risk of serious fungal urinary tract infection (UTI) may be increased. We present the case of a 67-year-old Caucasian female who was admitted for emphysematous pyelitis and found to have a fungal ball in the renal pelvis. Candida glabrata was cultured and the patient was managed with percutaneous nephrostomy tube placement and antifungal treatment. The fungal ball persisted and required surgical removal with ureteroscopy and basket extraction. Fungal balls can be a difficult sequelae of UTIs requiring a combination of antifungal and surgical intervention for definitive management.