Malacoplakia causing bilateral ureteropelvic junction obstruction

Malacoplakia presenting with obstructive nephropathy with bilateral ureter involvement

BACKGROUND

A 48-year-old woman with chronic urinary tract infections presented with uremia. Imaging studies revealed bilateral hydronephrosis and segmental ureteral thickening.

INVESTIGATIONS

Physical examination, urine and blood analysis, radiography of the chest, chest CT, abdominal and pelvis CT, renal ultrasonography, cystoscopy, anterograde pyelogram, bladder biopsy.

DIAGNOSIS

Malacoplakia involving bilatateral ureters and bladder; cavitary pneumonia.

MANAGEMENT

Hemodialysis, placement of bilateral percutaneous nephrostomy tubes, administration of ciprofloxacin, ascorbic acid and bethanechol.

A case of acute renal failure caused by bilateral, multifocal malacoplakia lesions of the bladder and ureters

BACKGROUND

A 51-year-old woman with a history of hypertension and a 5-year history of recurrent perimenopausal Escherichia coli urinary tract infections presented with fatigue. She had a history of occasional urinary frequency, but denied gross hematuria, flank pain, abdominal pain, immunodeficiency or immunosuppression.

INVESTIGATIONS

Basic metabolic profile, ultrasonography, cystoscopy, retrograde pyelography, pathologic evaluation of resected lesions from the bladder, ureteroscopy, pathologic evaluation of resected lesions from the ureters, and MRI.

DIAGNOSIS

Acute renal failure caused by bilateral, multifocal malacoplakia lesions of the bladder and ureters.

MANAGEMENT

Endoscopic resection and laser ablation, ureteral stent placement, and medical treatment with fluoroquinolones, vitamin C and bethanechol.

Malacoplakia: a 25-year experience with a review of the literature

Our experience with 9 cases of genitourinary malacoplakia is reviewed. The bladder was involved in 4 patients, ureter in 2, prostate in 1, testis in 1 and a combination of prostate, bladder, rectum and pelvic adnexae in 1. The female-to-male ratio was 2:1. Escherichia coli was present in 7 of 8 available urine cultures. Of 9 patients 2 had associated immunocompromised conditions. A variety of therapeutic approaches were chosen, depending mainly on location and extent of disease. These varying combinations of medical and surgical therapies produced resolution of disease in 8 of 9 patients. Generally, upper tract involvement requires surgical intervention, while most cases of lower tract involvement can be managed with antibiotics and endoscopic resection. Rare cases of extensive lower tract malacoplakia may require extirpation for cure.

Malacoplakia of the ureter

Malacoplakia of the urinary tract affects primarily the bladder and secondarily the distal ureter. Characteristic gross and microscopic lesions have been well described. A case of malacoplakia is reported in a 55-year-old woman who presented with hydronephrosis in a solitary kidney. The only lesion in the urinary tract was an apple-core type mass of the distal ureter, which was resected. This represents a rare and unusual presentation of malacoplakia. The differential diagnosis and pertinent literature are discussed.

Bilateral renal malakoplakia

A case of malakoplakia is presented which was confined to the renal parenchyma of both kidneys in a thirty-five-year-old woman in whom fatal renal failure developed in three weeks. Bilateral renal malakoplakia is rare, and unlike malakoplakia of the bladder, it behaves as a progressive, destructive, and fatal disease.

Renal malacoplakia

A case of malacoplakia of the kidney is presented. The incidental finding of asymptomatic pyuria focused attention on the urinary system. Urologic evaluation concluded an avascular renal mass. The diagnosis of malacoplakia was established only after histologic studies of the surgical specimen were completed. Purulent perinephritis complicated the postoperative outcome.

Renal malacoplakia

Malacoplakia often is considered a benign disease. Our recent experience with renal parenchymal malacoplakia and a review of the literature have revealed the clinical and pathologic features as well as the prognosis of this renal disease. Upper urinary tract malacoplakia is neither benign nor self-limited, and bilateral renal parenchymal involvement has been uniformly fatal.