title: A fatal mycotic sepsis after retrograde intrarenal surgery: a case report and literature review.
abstract: OBJECTIVE
  The retrograde intrarenal surgery (RIRS) is a procedure that sees an increase in its use every day and is supported by excellent results in terms of safety and feasibility. We report the first case of fatal mycotic septic complication in a neurological patient for renal stone disease.
  
  
  METHODS
  The case of a woman 44 year-old, with left solitary kidney and history of advanced multiple sclerosis, epilepsy, bedridden and percutaneous endoscopic gastrostomy was described. She was hospitalized for the presence of recurrent lower urinary tract infections. The computed tomography (CT) scan control revealed a 1.7 cm obstructive renal pelvic stone and multiple stones in the bladder. After the refusal of a percutaneous approach, a RIRS was planned and done. No intraoperative complications were observed. In the postoperative period, she developed a urinary sepsis with progressive deterioration of the general conditions. She died 6 days after the RIRS for septic shock with a blood culture positive for Candida glabrata.
  
  
  CONCLUSIONS
  A Pubmed search for fatal complications after RIRS shows only two cases not fully elucidated.
  
  
  CONCLUSIONS
  The use of flexible ureteroscopes and holmium lasers has a high succes rate;nevertheless, the possibility of a major complication should be kept in mind in order to evaluate all the risk factors, to adopt all the preventive measures for the safety of the patients.
authors.affiliation:  Urology Department, San Pio da Pietrelcina Hospital, Vasto (Chieti) - Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.affiliation:  Urology Department, San Pio da Pietrelcina Hospital, Vasto (Chieti) - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Berardinelli
authors.affiliation:  Urology Department, "G. D'Annunzio" University, Chieti - Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Castellan
authors.affiliation:  Urology Department, Humanitas Gavezzani Hospital, Bergamo - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Castellucci
authors.affiliation:  Urology Department, San Pio da Pietrelcina Hospital, Vasto (Chieti) - Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pellegrini
authors.affiliation:  Urology Department, San Pio da Pietrelcina Hospital, Vasto (Chieti) - Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
mesh_terms: D000328:Adult; D058387:Candidemia / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods