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Malacoplakia of the urinary tract

Dr Amir Rezaee and Radswiki et al.

Malacoplakia of the urinary system is an uncommon chronic granulomatous inflammatory disease of the bladder wall. Malakoplakia (meaning soft plaque) can affect any organ but urinary bladder is the commonest location.

Epidemiology

Malacoplakia has a peak incidence in middle age, and has a female to male ratio of 4:1 1. The disease is more common in patients who are immunocompromised or those with diabetes mellitus. 

Clinical presentation

Presenting symptoms include gross hematuria and signs of urinary tract infection, with Escherichia coli infection being very commonly found to coexist.  

Pathology

Although infection with E. Coli is very commonly observed but impaired host defence and defective phagocytosis is considered important part of the pathogenesis 1.

Michaelis-Gutmann bodies are histologic hallmark which are intracellular inclusions in the large histiocyts containing calcium 2.

Location

Within the urinary tract, the bladder is the most frequently affected organ (40% of patients with malacoplakia)

Radiographic features

Imaging characteristics of malacoplakia are varied, and most commonly observed within the bladder, although plaques may also occur in the ureters.

Malacoplakia may present as multiple, polypoid, vascular, solid masses or as circumferential wall thickening, associated with vesicoureteral reflux and dilatation of the upper urinary tract. These masses vary in size from a few millimeters to several centimeters. Occasionally, malakoplakias can be locally aggressive and invades surrounding structures even causing bone erosions 1.  

Treatment and prognosis

Although malacoplakia may be extremely aggressive, invading the perivesical space, and it can even cause bone destruction, non-surgical medical management is the mainstay of treatment, and as such biopsy for accurate diagnosis is essential. 

Treatment regimens include antibiotics, ascorbic acid, and a cholinergic agonist 1.

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