Candida albicans "fungus ball" in bladder.

With the use of antibacterial agents, the incidence of fungal infections has risen. The urinary tract is susceptible to these superinfections. We report, herein, a case of candidiasis of the bladder that demonstrates the classic radiographic findings of “fungus ball” in the bladder. A sixty-four-year-old white male presented in This revealed a large epithelialized cavity in acute urinary retention with urosepsis, congestive the place of the prostate, the roof of which was heart failure, and severely uncontrolled diabetes the vesical trigone containing the ureteral mellitus. One year prior to admission he was orifices. Two large yellow-brown oval masses hospitalized and required Foley catheter drainwere free floating in the bladder. There was age and antibiotics. At that time he was diagno evidence of outflow tract obstruction. Open nosed as having a ruptured prostatic abscess, cystotomy was then performed, and two large and purulent material drained per urethra for several days after catheter removal. The patient voided freely until four months prior to this admission when obstructive symptoms developed. Physical examination on admission revealed a febrile male in congestive heart failure; the prostate gland was flat and benign. Laboratory data demonstrated a hematocrit of 35, a hemoglobin of 11 Cm. per 100 ml., and a white blood count of 17,100 cells per cubic millimeter. The blood glucose was 476 mg., the blood urea nitrogen was 49 mg., and the serum creatinine was 1.4 mg. per 100 ml. Urinalysis revealed 25 to 30 white blood cells per high-power field with bacteria. No fungal forms were identified. Urine culture showed Proteus mirabilis and enterococcus. Excretory urography demonstrated normal upper tracts (Fig. 1). On the scout film and later films a large, laminated, partly radiodense circular mass was seen in the region of the bladder. The patient was managed initially with an indwelling Foley catheter and antibiotics and, FIGURE 1. C ystographic appearance of fungus when medically stable, underwent endoscopy. ball showing laminated mass. 662 UROLOGY / JUNE1977 / VOLUMEIX, NUMBER6 FIGURE 2. (A) Operative removal of two fungal masses from urinary bladder. (B) Cross section and dimensions of fungal-masses. fungus balls were removed. Culture of these masses revealed Candida albicans, and histologic confirmation of budding yeast was obtained. Two weeks postoperatively after catheter removal the patient voided freely and has remained free of obstructive symptoms (Fig. 2).