title: [Pyeloureteral fungus ball in patients with urinary lithiasis. Treatment with ureterorenoscopy].
abstract: BACKGROUND
  C. albicans is the most frequent fungus causing opportunist infections of the urinary tract. Agglutination of necrotic tissue nucleus (papilary necrosis), mucosus debri and chirurgic or lithiasic debri, originates a fungus ball, which can obstruct the urinary tract at any level.
  
  
  METHODS
  We present 2 patients with obstructive urinary lithiasis developing fungus ball in the dilated upper urinary tract. Patient 1 was bilaterally affected and never had systemic symptoms. Treatment consisted of uretherorrenoscope for removal of fungus ball, bilateral urinary diversion and anphotericine B irrigations and systemic. Patient 2 developed a candidemia and was treated with systemic liposomal anphotericine B, uretherorrenoscopy with removal of ureteric calculus and fungus ball, and placement of a double J catheter and nephrostomy tube for anphotericine B irrigation.
  
  
  CONCLUSIONS
  Urinary lithiasis is a risk factor for fungal infection of the upper urinary tract, provided there is no other predisponent factor for opportunistic fungal infections. Calculi facilitates fungal growth by means of obstruction and subsequent retrograde estasis and creating a nucleus for growth, aggregation and ramification of mycelium. The infection pathway is probably ascendent and may turn into fungemia and septicaemia. Systemic antimicotics, urinary diversion and local irrigations with antimicotics, and endourologic technics, are the three basic items in the treatment. Ureterorrenoscopy plays an important roll as a diagnostic and therapeutic tool as it may solve the obstruction and allows removal of fungus ball.
authors.affiliation: Servicio de Urología, Hospital Universitario La Fe, Valencia.
authors.forename: J P
authors.initials: JP
authors.lastname: Burgués Gasión
authors.forename: J M
authors.initials: JM
authors.lastname: Alapont Alacreu
authors.forename: F
authors.initials: F
authors.lastname: Oliver Amorós
authors.forename: A
authors.initials: A
authors.lastname: Benedicto Redón
authors.forename: F
authors.initials: F
authors.lastname: Boronat Tormo
authors.forename: J F
authors.initials: JF
authors.lastname: Jiménez Cruz
mesh_terms: D000368:Aged; D002177:Candidiasis / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D018666:Ureteroscopy; D014545:Urinary Calculi / Q000150:complications* / Q000628:therapy*; D014552:Urinary Tract Infections / Q000150:complications* / Q000628:therapy*
vernacular_title: Fungus ball pieloureteral en pacientes con litiasis urinaria. Tratamiento con ureterorrenoscopia.