Ureteral calculus complicated by bladder malakoplakia: A case report.

RATIONALE: Bladder malakoplakia is a rare granulomatous inflammatory condition that mimics bladder tumors clinically and radiologically. This case is reported to highlight diagnostic challenges and prevent unnecessary radical surgery, emphasizing the critical role of histopathology in identifying this underrecognized entity.

PATIENT CONCERNS: A female patient presented with recurrent urinary frequency persisting for >1 year. No hematuria, dysuria, or flank pain was reported.

DIAGNOSES: Diagnoses included bladder tumors, right renal calculus and upper ureteral calculus with hydronephrosis, renal cortical thinning, and hypertension. The postoperative pathology confirmed bladder malakoplakia. Histopathology identified characteristic Michaelis-Gutmann bodies.

INTERVENTIONS: Transurethral resection of bladder tumor and laparoscopic ureterolithotomy. No adjuvant immunotherapy or long-term antibiotics administered postoperatively.

OUTCOMES: Successful resection of bladder lesion. Resolution of lower urinary tract symptoms at 3-month follow-up. No recurrence on follow-up cystoscopy.

LESSONS: Malakoplakia should be considered in the differential diagnosis of bladder masses, particularly when unresponsive to standard therapies. Histopathological identification of Michaelis-Gutmann bodies remains the diagnostic gold standard. Conservative resection (transurethral resection of bladder tumor) provides both diagnostic confirmation and therapeutic efficacy. Associated urinary tract abnormalities (e.g., obstructive calculi) may contribute to pathogenesis and require concurrent management.