title: Percutaneous nephrostomy for nonoperative management of fungal urinary tract infections.
abstract: OBJECTIVE
  Percutaneous nephrostomy has proved to be an important modality in the nonoperative treatment of bacterial pyonephrosis. The role of this technique in the management of fungal pyonephrosis continues to evolve. The authors retrospectively reviewed their experience with percutaneous nephrostomy in the management of fungal pyonephrosis.
  
  
  METHODS
  Seven patients, two neonates and five adults, were identified with proved fungal infections. Eleven percutaneous nephrostomy tubes were placed, all with use of the Seldinger technique.
  
  
  RESULTS
  Percutaneous nephrostomy allowed (a) prompt microbiologic diagnosis of fungal infection (Candida albicans in six patients, Torulopsis glabrata in one); (b) urinary diversion with subsequent improvement in renal function, enabling systemic administration of potentially toxic antifungal drugs 5-fluorocytosine and amphotericin B (four patients); (c) local irrigation with amphotericin B (four patients), (d) guidewire fragmentation of fungus balls (two patients); and (e) introduction of a Simpson atherectomy device to obtain biopsy specimens from an obstructing ureteral polypoid lesion (one patient). The funguria was successfully eradicated in six patients, one of whom died on the 39th hospital day of a pulmonary embolus and another of whom died of extensive small bowel infarction during hospitalization. The one patient whose outcome of antifungal treatment remains unknown died at home with a functioning percutaneous nephrostomy 23 days after the procedure.
  
  
  CONCLUSIONS
  Percutaneous nephrostomy may play a role in the non-operative management of fungal urinary tract infection.
authors: Department of Radiology, University of Utah School of Medicine, Salt Lake City.
authors: D A
authors: DA
authors: Bell
authors: S C
authors: SC
authors: Rose
authors: N K
authors: NK
authors: Starr
authors: R B
authors: RB
authors: Jaffe
authors: F J
authors: FJ
authors: Miller
mesh_terms: D000368:Aged; D002177:Candidiasis / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000382:microbiology / Q000628:therapy*