Repeated Spontaneous Transurethral Passage of Urinary Fungal Masses Associated with Candida tropicalis Candiduria in a Diabetic Patient with Multiple Urinary Calculi: A Case Report.

PURPOSE: Repeated spontaneous transurethral passage of visible urinary fungal masses containing Candida organisms is rare. We report a case associated with Candida tropicalis (C. tropicalis) candiduria in a patient with poorly controlled diabetes mellitus and multiple urinary calculi. CASE: A 55-year-old man with poorly controlled diabetes mellitus, urinary calculi, urinary retention, bilateral hydronephrosis, and recent cystolitholapaxy presented with dysuria, pyuria, and repeated passage of yellow-white soft masses during urination. Cystoscopy and computed tomography showed intravesical lesions accompanied by bladder inflammation. Histopathological examination of the expelled masses demonstrated abundant Candida organisms within necroinflammatory debris, whereas urine culture yielded fluconazole-susceptible C. tropicalis. Passage of the fungal masses, dysuria, and pyuria persisted during the early course of fluconazole treatment. After adjunctive caspofungin was added together with intensified glycemic control, urinary drainage, daily bladder irrigation, and local perineal care, the frequency and volume of the expelled masses decreased, and the urinary symptoms and pyuria improved. CONCLUSION: Visible urinary fungal masses in patients with candiduria should undergo histopathological examination, while urine and, when feasible, the expelled material should be submitted for fungal culture and species identification. Management of complicated candiduria should combine appropriate antifungal therapy with urinary drainage, glycemic control, bladder irrigation, and other source-control measures.