In the decades, since the advent of shockwave lithotripsy, instrumentation and techniques in both ureteroscopic and percutaneous stone management have improved exponentially, leading to both increased success and lower complication rates. As a result, there have been some controversies revolving around the therapeutic modality of choice for specific stones in terms of their size and location. This review seeks to provide some clarity to the decision-making process with emphasis on patient comfort and choice and due consideration being given to the potential complications associated with the various treatment modalities.

Fungal bezoar is a very rare clinical entity that usually results from fungemia because of uncontrolled diabetes mellitus or immunosuppression. Most cases present in the upper urinary tract, but there have been less than 10 reported as presenting primarily in the bladder. Treatment is largely medical with antifungal therapies with no documented cases of concomitant bacterial colonization. Rarely, surgical intervention is warranted, but there are no documented surgical approaches with a bipolar cautery loop resectoscope. We present a case of a fungal bezoar of the bladder that was treated with transurethral resection. The presence of multidrug-resistant organisms resulted in postoperative sepsis controlled with intravesical and intravenous antibiotics and fluid resuscitation.