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WCE 2018: Outcomes of Endourologic Intervention in Patients with Pre-Operative Funguria

Paris, France (UroToday.com) Funguria is a relatively rare finding with occurrence rate between 1-5% in cultures urine specimens. Most of the time, the discovered pathogen is of the Candida species, specifically Candida Albicans, Candida Glabrata, and Candida Tropicalis. The authors of this study conducted a retrospective analysis of characteristics and outcomes in patients with pre-operative funguria who underwent endourologic intervention.

Sixty-five patients with funguria were analyzed, 49 (75.4%) of which underwent ureteroscopy and 16 (24.6%) who underwent percutaneous nephrolithotomy (PCNL). Thirty-two patients (49.6%) cultures grew Candida albicans, while 17 patients (26.2%) grew Candida glabrata, and 16 (24.6%) grew Candida, species not specified. The average BMI of patients was 31.8±11.0 and the average Charleson Comorbidity Index was 2.52±2.0. Prior antibiotic usage within the last 3 months was evident for 57 (87.7%) patients. Carbonate Apatite stones and Calcium Oxalate stones were encountered in 43.1% and 50% of patients respectively. Eighteen (27.6%) of patients met SIRS criteria postoperatively and 11 (16.9%) required ICU admission. However, no patients in this cohort died within 30 day of procedure. 

This study revealed that prior antibiotic use, urinary catheterization, and comorbidity status is associated with pre-operative funguria. During univariate analysis, presence of an indwelling catheter (p=0.009), having neurogenic bladder (p=0.02), or C. glabrata on preoperative culture (p=0.04), and longer operative time (p=0.04) were predictive of developing post-operative SIRS, but these effect sizes were not apparent on multivariable analysis. The authors hypothesize that funguria itself may not necessarily lead to complications or confer a worse prognostic status to a patient, but instead that patients with funguria tend to be a sicker population. This cohort may have many comorbidities and have a worse health status overall, which may predispose to developing complications down the line. Therefore, funguria may be a marker of a patient at risk for deterioration, and thus may require more intensive management.

Presented By: Todd Yecies, MD, University of Pittsburgh School of Medicine 

Other Authors: Anand Mohapatra, MD, Mohamed Yassin, Michelle Semins, MD

Written By: Max Towe for UroToday at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France