Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic lower urinary tract symptoms (LUTS), including recurrent urinary tract infections (UTIs), dysuria, frequency, and urgency. History of persistent hematuria or suprapubic discomfort. No history of immunosuppression or recent instrumentation noted. Symptoms refractory to standard antibiotic courses.
Clinical Examination Findings
Abdominal examination reveals mild suprapubic tenderness without palpable masses or organomegaly. Digital rectal examination (DRE) unremarkable. Cystoscopic findings: Presence of multiple, soft, yellowish-tan, slightly raised mucosal plaques or nodules within the bladder wall, often surrounded by erythema. Biopsy confirms Michaelis-Gutmann bodies on histopathology.
Treatment Protocol
Initiate long-term antibiotic therapy with intracellular penetration (e.g., Fluoroquinolones like Ciprofloxacin or Trimethoprim-Sulfamethoxazole). Consider adjunctive therapy with bethanechol chloride to enhance macrophage phagocytic activity. Surgical management via transurethral resection (TURB) of the malacoplakic lesions for debulking and definitive diagnosis. Monitor for recurrence via periodic cystoscopy.