Malacoplakia of the Urinary Tract: Challenges and Frustrations with 10 Cases

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Abstract
Experience with 10 cases of malacoplakia of the urinary tract is reviewed. The bladder was affected in all 10 patients, in addition to both ureters in 1, possibly 1 ureter in 1 and the urethra in 1 patient. Symptoms were noted in 9 patients and intercurrent chronic liver disease was present in 3. Treatment of bladder lesions was by fulguration only in 1 patient, fulguration and short-term antimicrobial therapy in 5, fulguration and long-term therapy in 3 and thio-tepa instillation in addition to fulguration and long-term antimicrobial therapy in 1. A patient with ureteral involvement underwent temporary nephrostomy and the one with the urethral lesion healed after prolonged antimicrobial therapy. Recurrence was rare in 3 patients who received long-term antimicrobial therapy with prolonged followup. Fulguration and long-term antimicrobial therapy are therapies of choice for bladder lesions. Upper urinary tract lesions should be managed by long-term antimicrobial therapy and conservative operations as indications arise. It is possible that this disease is an immunodeficiency disorder and patients should be followed carefully.