# Endoscopic removal of fungal balls using an access sheath and bendable suction device during URS: A novel approach

## TL;DR

A high-risk patient with kidney fungal balls and stones was successfully treated using a new endoscopic method involving suction and laser.

## Contribution

This is the first report of in toto removal of renal fungal balls using suction-assisted URS in a high-risk patient.

## Key findings

- Flexible ureterorenoscopy with suction-assisted access sheath enabled complete removal of fungal balls.
- Laser lithotripsy was used to clear a concomitant stone during the same procedure.
- The method offers a minimally invasive alternative to percutaneous nephrolithotomy (PNL).

## Abstract

We report the case of a high-risk patient with candidemia and obstructive uropathy caused by renal fungal balls. Initial management with systemic antifungals and stenting was insufficient. Given the patient's dual antiplatelet therapy, we opted for flexible ureterorenoscopy utilizing a bendable ureteral access sheath with an integrated suction device. This enabled in toto removal of fungal balls and efficient clearance of a concomitant stone using laser lithotripsy. To our knowledge, this is the first report demonstrating in toto removal of renal fungal balls using suction-assisted URS in a high-risk patient, offering a minimally invasive alternative to PNL.