[Fungal infections and ureteral material: How to manage?].
BACKGROUND
Urinary tract infections due to Candida species are mostly encountered in hospital environment. The management of candiduria on ureteral catheter is not consensual. The objective of our work was to make a review of medical literature related to definition, physiopathology, management and prevention of candiduria on ureteral catheter.


METHODS
The research was made on Medline using the following keywords: Candida; fungal; urinary tract infection; ureteral stent; ureteric stent; double-J pigtail.


RESULTS
The threshold defining candiduria is 10(5) CFU/mL. Candiduria corresponds to many different clinical presentations from colonization to candidemia. Species found are mostly Candida albicans (19-72%) and Candida glabrata (15.6-49.4%). The colonization of ureteral stent due to Candida is of 10% and comes with candiduria in 40% of the cases, due to the presence of biofilm. Prevention of infections on ureteral stents requires a regular change of material every 3-6 months depending on the patients risk groups. In case of symptomatic candiduria on ureteral stent, an anti-fungal therapy should be initiated 48 hours to 3 weeks before the change of the stent, in order to get a sterilization of urines and prevent the recolonization of the stent. Fluconazole is the drug of choice to use.


CONCLUSIONS
Colonization of ureteral stents due to Candida is common and can be responsible of symptomatic infection. Anti-fungal therapy should be introduced before the change of the stent but a consensual duration of treatment before surgery is not found in the literature.
Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France. Electronic address: dcharlie8@hotmail.com.
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Dariane
Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Cornu
Service de maladies infectieuses, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Esteve
Service de maladies infectieuses, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Cordel
Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Egrot
Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Traxer
Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Haab
D002177:Candidiasis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D055499:Catheter-Related Infections / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D014513:Ureter; D014546:Urinary Catheterization / Q000295:instrumentation*; D014552:Urinary Tract Infections / Q000209:etiology* / Q000628:therapy*
Candiduria; Candidurie; Double-J; Double-pigtail ureteric stent; Drainage urinaire; Fongurie; Fungiuria; Infection urinaire; Prothèse endo-urétérale; Sonde JJ; Stent urétéral de type double-J; Ureteral stent; Urinary stenting; Urinary tract infection