MALACOPLAKIA OF THE URINARY TRACT: CHALLENGES AND FRUSTRATIONS WITH 10 CASES

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 has been rare in 3 patients who received long-term antimicrobial therapy with prolonged followup. We believe that 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, therefore, patients should be followed carefully.