Fungal Urinary Tract Infection: A Brief Manual for Diagnosis and Treatment for Urologists

Abstract

The detection of fungi in urine is common, particularly in nosocomial settings. Nevertheless, diagnostic and treatment approaches are often associated with uncertainty. Accordingly, this review aimed to give a concise overview of fungal urinary tract infection (UTI) as a supplement to the more comprehensive update of the European Association of Urology 2026 Guidelines on Urological Infections. Only 2–11% of fungal isolates in urine are associated with symptoms, and a fungal UTI should only be assumed in such cases. Candida albicans is the most frequently identified pathogen. Diagnosis should include a urine culture with susceptibility testing, especially in non-albicans Candida UTI. Nonantimicrobial measures such as catheter replacement should always be part of the treatment. First-line antimicrobial treatment is fluconazole. In cases of localized bladder infections, intravesical amphotericin B may be considered. Asymptomatic funguria should only be treated in exceptional cases. Urologists should play a key role in treatment decision-making for patients with fungal UTIs.