Malakoplakia is one of the rare bladder and urinary tract diseases that can also occur in other places. The diagnosis is made in the laboratory and with different imaging methods. As a rule, it can be treated with medication, which is why surgical measures are rarely required.
What is malakoplakia?
According to Electronicsencyclopedia, Malakoplakia is a chronic urinary tract inflammation of the gastrointestinal tract and other organ systems such as the kidneys, ureters and gastrointestinal tract. In addition, malakoplakia can also affect the lungs, throat, tongue, genital tract, skin, and central nervous system.
Cystoscopy shows multiple flat protrusions of the mucosa, some of which are raised, whitish-grey and plaque-like. Macroscopically, the mucosa may appear with a hemorrhagic rim, as described cystoscopically. The lesion can solidify over time due to scarring processes.
Even if the urinary bladder in women is most frequently affected, it can happen that other urinary tract organs are also affected from the start or during the course of the disease. It is not uncommon for there to be an immune deficiency, an immune deficiency or a tumor. It mostly affects people over the age of 50 with a chronic E. coli infection.
Women are four times more likely to get the disease than men. The prognosis for malakoplakia of the urinary bladder or a unilateral involvement of the kidney is good after adequate therapy. However, if the kidneys are bilaterally involved, mortality within six months is high.
Causes
One cause of maloplakia is a non-intact intraphagosomal bacterial decomposition of macrophages triggered in connection with a chronic bacterial infection. The nidus for the formation of intracellular Michaelis-Gutmann bodies are the undegraded remains of the bacterial colonization. Risk factors are chronic urinary tract infections with E. coli (in 90 percent of cases), an immune deficiency or malignant disease or other systemic diseases with a debilitating effect.
A defect in the monocytes or macrophages should also be considered as a possible cause. The monocytes circulating in the bloodstream are responsible for the formation of macrophages. After their transformation into large and mobile cells, these macrophages belong to the cellular immune system.
There they absorb pathogens and bacteria, digest them and thus render them harmless. That is why the macrophages are also called scavenger cells. If this defense process is disturbed, the macrophages absorb the bacteria, but only incompletely digest them. The improperly digested bacteria accumulate. The result is a granulomatous accumulation of cells in response to the immune cells.
Symptoms, Ailments & Signs
If the urinary tract is affected by malakoplakia, then this is shown by chronic urinary tract infections, an increased urge to urinate, but also red blood cells in the urine, which is referred to as hematuria. If the intestines are affected, the symptoms are constant or constantly recurring diarrhea (diarrhea), body and/or abdominal pain and a feeling of fullness.
Vaginal bleeding clearly indicates a disease of the genital tract. Papules, itchy rashes but also ulcers in the abdominal area or in the face or anal region indicate that the skin is suffering from malakoplakia. Nonspecific symptoms include pain and fever. It is quite possible that malakoplakia is associated with granulomatous diseases such as tuberculosis or carcinomas, for example prostate carcinoma.
Diagnosis & course of disease
At the beginning there is the anamnesis with questions about current symptoms and problems. This is followed by the localization and the determination of when, how often and with what intensity they occur. This differential diagnosis forms the basis for the subsequent examinations and therapies. In the laboratory, a urine culture and a blood culture are used to determine what the laboratory values are like. This is followed by the radiological diagnosis with a sonography and a CT of the abdomen.
During the urogram, also called urography, an X-ray contrast image is created. The imaging of early urography after a few minutes of contrast injection is compared to late urography within 24 hours. Functional disorders of the kidneys, an inhibition of excretion, but also an obstruction of the urinary tract can be detected.
In the case of urotomography, excretory urography, tomograms (approximately five to ten minutes pi) are made. A late urogram can be added.
Infusion urography is used after intravenous administration of a large amount of contrast medium to visualize the urinary tract. This examination can also be carried out in the case of renal insufficiency and insufficient preparation. The display has a high intensity.
in a CT abdomen, slice-by-slice images of the abdomen are made. This makes it possible to assess not only the shape and position, but also the condition of tissue and organs. Pathological changes and tissue changes can be assessed directly.
Endoscopy is often the method of choice for reliable diagnosis. The examination of the urinary bladder, including the urethra in men, involves a cytoscopy with a cytoscope, also called urethrocystoscopy. For this examination, the bladder is filled with a sterile liquid.
With the small camera on the cytoscope, the doctor can examine and diagnose the bladder as if under a magnifying glass. The yellowish-white nodules and plaque deposits on the tissue can thus be clearly detected. The ultimate certainty can be obtained with a histological finding. Recognizable lesions and other changes are subjected to tissue removal ( biopsy ).
Histology shows large histiocytes, so-called Hansemann cells, but also small basophilic and intracytoplasmic inclusion bodies (Michaelis-Gutmann bodies) from an extracellular matrix, which are pathognomonic.
If the urinary bladder is affected, dysuria must be clarified in the same way as pollakiuria and hematuria. A urinary stasis kidney and a renal involvement with radiological signs of masses must also be clarified, since there can be a close consensus. In men, the testicles must be included in the examinations.
Complications
Malakoplakia causes those affected to suffer from symptoms that mainly occur in the bladder or urinary tract. It is not uncommon for these complaints to have an effect on the patient’s psyche, resulting in mental health problems or depression. Patients also suffer from abdominal pain and a feeling of fullness.
Women can be affected by unexpected vaginal bleeding and mood swings. There are also rashes and itching on the skin, so that the quality of life of those affected is significantly restricted by malakoplakia. Ulcers can form in the abdomen and cause pain.
It is not uncommon for the patient to experience fever and general exhaustion. In many cases, various forms of cancer develop, which in the worst case can lead to the death of the patient. In this case, the life expectancy of the patient is also significantly reduced.
Malakoplakia is treated with medication. Complications do not usually occur, but not all symptoms can always be completely limited. In the worst case, those affected suffer from renal insufficiency and die from the symptoms of malakoplakia.
When should you go to the doctor?
If the person concerned repeatedly suffers from a urinary tract infection, this should be discussed with the doctor treating you. If there is persistent pain or trouble urinating, a doctor’s visit is necessary so that the cause of the symptoms can be determined. An urge to urinate that occurs again shortly after a successful visit to the toilet is an indication of an existing irregularity in the organism. If this complaint persists for several weeks or days, a doctor should be consulted. Digestive disorders, intestinal noises or diarrhea require medical attention from a doctor.
If there is inner restlessness, increasing irritability, if the affected person’s performance decreases or if there is an increased need for sleep, a doctor should be consulted. If there are changes in the complexion of the skin, further medical tests are required to determine the cause. If a rash develops or the skin becomes itchy, the abnormalities should be examined by a doctor. In the case of open wounds, sterile wound care is necessary so that no further diseases or complications arise. If blood is noticed in the urine or if vaginal bleeding occurs that is not related to the female menstrual period, a doctor should be consulted as soon as possible.
Treatment & Therapy
Long-term antibiosis with fluoroquinolones (gyrase inhibitors) is administered with medication. Co-trimocazole, rifampicin, sulfanamides and dozycycline are known. So far, however, there is no uniform duration of treatment, so that long-term therapy is usually assumed.
In rare cases, surgical rehabilitation by means of resection or ureter splinting ( nephrectomy ) is required. For example, in pseudotumorous stages of development, surgical resection is required. A nephrectomy or partial nephrectomy is often performed after long- term chemotherapy with, for example, trimethoprim-sulfamethoxazole.
In any case, the decision should be made depending on the symptoms and organ function. The prognosis is now positive. However, after treatment of a urinary tract involvement or urinary tract disease has been completed, renal failure can occur due to a recurrence.
Outlook & Forecast
The chronic inflammation of the urinary tract has a good prognosis if the affected person seeks cooperation with a doctor. In most cases, long-term therapy is required so that significant relief of the symptoms can occur and, with a favorable course, recovery can be achieved. The administration of medication is necessary so that the organism is sufficiently strengthened in the healing process. Without medication, the symptoms usually persist for a long time. In addition, the risk of secondary diseases is increased. The impairments usually spread to other physical areas or attack the stability of the psyche. This can lead to the development of additional diseases as the disease progresses.
For a good prognosis, it has been shown that, in addition to drug treatment, a significant improvement in the situation is achieved if psychotherapeutic support is also provided. Conditions of emotional and mental stress have a significant proportion of physical irregularities. In the case of chronic underlying diseases in particular, this fact should be taken into account in medical care. In a large number of cases, improvements are seen as soon as the person concerned eliminates existing stressors from everyday life, processes the events they have experienced and cognitive restructuring takes place. In many patients, the improvement in lifestyle also plays a significant role in a good prognosis.
Prevention
So far, neither in conventional medicine nor in homeopathic naturopathy are there any known ways and means of preventing malakoplakia. In order for this disease to be detected in the early stages, a urological examination should be carried out at least once a year. If symptoms occur, a direct examination by the urologist is advisable. In the early stages, drug treatment as described here is almost always sufficient.
Aftercare
Because treatment for malakoplakia is relatively complex and lengthy, follow-up care focuses on managing the condition safely. Those affected should try to focus on a positive healing process despite the adversity. To establish the right attitude, relaxation exercises and meditation can help calm and focus the mind. This is a basic requirement for recovery.
Due to malakoplakia, those affected primarily suffer from severe diarrhea, abdominal pain and a feeling of fullness. Dehydration also occurs as a result of the persistent diarrhea, so that the general condition of the person concerned deteriorates. In women, the disease can cause vaginal bleeding. Many patients struggle with inferiority complexes because they are ashamed of the symptoms. If this is reflected in a serious depression and other psychological upset, consulting a psychologist can be helpful to clarify the extent to which therapy is appropriate.
You can do that yourself
Malakoplakia must be diagnosed and treated by a doctor. In addition to long-term antibiotic treatment, the patient should take it easy. The most important measure is to support the functioning of the urinary tract by drinking enough fluids. The diet must not contain any foods that could burden the bladder and urinary tract. For example, foods containing citrus, lemon juice and alcoholic beverages should be avoided. The antibiotic treatment can be supported by bed rest and later by gentle exercise. The intimate area must be kept warm to avoid further urinary tract disease.
Depending on which symptoms are present and how much the organ function is impaired, homeopathic treatment can be useful. Belladonna and arnica, for example, as well as globules made from the active ingredients of devil’s claw are effective. In order to avoid interactions with the antibiotics taken, an alternative treatment should first be discussed with the responsible doctor.
After the therapy has been completed, the patient must have regular check-ups. Close monitoring is the only way to detect a renewed outbreak at an early stage. If the typical symptoms occur, an immediate clarification by the urologist is indicated.