Fungal bezoars of the upper urinary tract.
We report our experience with 6 cases of upper tract fungal bezoars involving 9 renal units-3 bilateral aspergillomas and 3 Candida bezoars. The Aspergillus bezoars were notably more morbid: 2 patients required nephrectomy after failure of medical therapy, whereas the 3 unilateral Candida bezoars all resolved with medical therapy and endourological access. In 1 patient whose aspergilloma was resistant to amphotericin B the investigational drug itraconazole proved effective. These opportunistic infections, seen increasingly in immunocompromised patients, can present a difficult management problem. A combined approach is necessary, including medical therapy with topical and systemic antifungal agents, and endourological access for extraction, lavage and debulking.
Irby
P B
PB
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
Stoller
M L
ML
McAninch
J W
JW
D000328:Adult; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D001630:Bezoars / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000628:therapy; D002177:Candidiasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy