








































This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Malakoplakia, urinary tract infections, urinary 
bladder, lower urinary tract symptoms

None declared.

Patient Consent: Obtained.

Received on December 3, 2021 
Accepted on December 11, 2021

Soc Int Urol J.2021;3(4):281–282

DOI: 10.48083/QFCW5582

FIGURE 1. 

Cystoscopy showing (A) malakoplakia nodules in the bladder and surrounding a severely dilated ureteric orifice (B)

281SIUJ.ORG SIUJ  •  Volume 3, Number 4  •  July 2022

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Malakoplakia Causing Poor Bladder Compliance  
and Bilateral Hydroureteronephrosis

Cecile T. Pham,1,2 Melanie Edwards,3 Amanda S.J. Chung,1,2 Venu Chalasani1,2

1 Department of Urology, Northern Beaches Hospital, Frenchs Forest, Australia  2 North Shore Urology Research Group, St Leonards, Australia   
3 Department of Anatomical Pathology, Douglass Hanley Moir Pathology, Macquarie Park, Australia

An 81-year-old female presented with lower urinary 
tract symptoms (LUTS) including frequency, urgency 
and urge incontinence. She had a 2-year history 
of recurrent urinar y tract infections (UTI) with 
Escherichia coli of varying susceptibility. Background 
history included rheumatoid arthritis treated with long-
term corticosteroids, and stage-4 chronic kidney disease 
due to hypertensive nephrosclerosis.

Non-contrast CT imaging showed severe bilateral 
hydroureteronephrosis to the level of the vesicoureteric 
junction and circumferential bladder wall thicken-
ing. The patient had a creatinine level of 221 μmol/L 
and eGFR rate of 18mL/min/1.73m2. Cystoscopy 

revealed diffuse erythema and white-yellow nodules 
(Figure  1). Histopathological examination of bladder 
biopsies demonstrated numerous Michaelis-Gutmann 
bodies, pathognomic for the rare chronic inf lamma-
tory condition malakoplakia (Figure 2)[1–5]. There 
was no evidence of dysplasia or malignancy. Urody-
namic assessment revealed increased bladder sensation 
and poor bladder compliance with impaired detrusor 
contractility.

Malakoplakia is usually associated with recurrent 
UTI, particularly Escherichia coli, Staphylococcus aureus, 
Proteus, and Klebsiella[4]. The patient was commenced 
on trimethoprim/sulfamethoxazole 150/100mg daily 

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mailto:cecile.pham%40icloud.com?subject=SIUJ
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prophylaxis, which was switched to cephalexin 500mg 
daily prophylaxis due to poor tolerance. She was also 
commenced on methenamine hippurate, supplemental 
vitamin C, and completed a course of Uromune for UTI 
prophylaxis.

The nodules had largely resolved on progress cystos-
copy four months later. At this time, she was treated with 

intravesical antibiotic wash using gentamicin 480mg 
diluted in 1L 0.9% sodium chloride.

This case demonstrates that malakoplakia can cause 
obstructive uropathy. It serves as a reminder to consider 
malakoplakia as a differential, particularly in women 
with recurrent UTI and immunosuppression.

References

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10.1097/00004347-200110000-00016

2. Bylund J, Pais VM Jr. A case of acute renal failure caused by bilateral, 
multifocal malacoplakia lesions of the bladder and ureters. Nat Clin 
Pract Urol.2008;5(9):516-519. doi:10.1038/ncpuro1173

3. Sanchez LM, Sanchez SI, Bailey JL. Malacoplakia presenting with 
obstructive nephropathy with bilateral ureter involvement. Nat Rev 
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4. Cavallone B, Serao A, Audino P, Di Stasio A, Tiranti D, Vota P. Bilateral 
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5. Stamatiou K, Chelioti E, Tsavari A, Koulia K, Papalexandrou A, 
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numonthly.18522

FIGURE 2. 

Histopathological images at x40 magnification with white arrows demonstrating the Michaelis-Gutmann bodies on 
(A) H&E stain and (B) von Kossa calcium stain

282 SIUJ  •  Volume 3, Number 4  •  July 2022 SIUJ.ORG

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