Cutaneous calicostomy for salvage urinary diversion.

OBJECTIVE: We describe a salvage technique for urinary diversion in the face of an obstructed, undilated upper urinary tract utilized in the management of a premature newborn infant with bilateral renal candidiasis, namely cutaneous calicostomy.

METHODS: An 850-g 24 weeks' gestation premature male infant developed obstructive nephropathy as a result of renal candidiasis. Systemic therapy with bilateral nephrostomy drainage and amphotericin B irrigations was repeatedly unsuccessful in eradicating the candiduria and fungal balls. Underlying bilateral proximal collecting system obstructions complicated the situation by rendering ureterostomy or pyelostomy impossible. Subsequent flank exploration was performed bilaterally, and bilateral cutaneous calicostomies were performed.

RESULTS: The patient's urinary tract was successfully diverted and the fungal balls eradicated. Renal ultrasounds and antegrade nephrostograms through the cutaneous calicostomy stomas revealed the procedure to be successful. Unfortunately, the patient eventually died from overwhelming non-urologic sepsis approximately 3 months postoperatively.

CONCLUSIONS: Although systemic antifungal therapy with bilateral nephrostomy drainage has been shown to be successful in the treatment of obstructive uropathy due to renal candidiasis, surgical intervention is necessary when recurrent sepsis with candiduria persists. In the event that underlying collecting system obstruction is also present, cutaneous calicostomy is an option to consider in the treatment of this disease.