THE ENIGMA OF CANDIDURIA - EVOLUTION OF BLADDER IRRIGATION WITH AMPHOTERICIN-B FOR MANAGEMENT - FROM ANECDOTE TO DOGMA AND A LESSON FROM MACHIAVELLI

Candiduria has emerged as a common, vexing diagnostic and therapeutic problem over the past 40 years. Treatment by means of bladder irrigation with a solution of amphotericin B has become widely used in clinical practice. However, the specifics of the procedure-concentration of amphotericin B, use of continuous washing vs. instillation with cross-clamping to allow ''dwell-times,'' and duration of treatment-are based entirely on anecdotal experiences. The published reports and evolution of recommendations are reviewed. A prospective randomized double-blind study is needed to provide answers. In the meantime, administration of 200-300 mL of amphotericin B solution by triple-lumen urethral catheter with cross-clamping for 60-90 minutes seems most appropriate. Irrigation for no longer than 2 days should suffice if the procedure is to be effective. The optimal concentration of amphotericin B has not been defined; however, 5-10 mg/L appears adequate.