以攝護腺膿瘍及急性尿滯留表現之攝護腺軟斑病:案例報告與文獻分析

蔡長佑、洪啟峰、黃彥儒、陳丕哲、沈正煌、林昌德

嘉義基督教醫院 外科部 泌尿科

Malakoplakia of the prostate presenting as prostate abscess with acute urine retention: A case report and literature review

Chang-Yu Tsai, Chi-Feng Hung, Yen-Ju Huang, Pi-Che Chen, Cheng-Huang Shen, Chang-Te Lin

Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital

Introduction: 

    Malakoplakia is a rare condition caused by chronic inflammation. In this article, we report a case with initial presentation of prostate abscess with acute urine retention. Related literatures of prostatic malakoplakia will be reviewed in this paper.

Case presentation: 

    This is a 69-year-old male with an underlying history of rheumatoid arthritis and type 2 diabetes mellitus who had suffered from acute urinary retention for 1 day. The patient then came to our emergency department for help. Mild fever with a temperature of 37.4’C was noted at arrival. Further laboratory examinations showed leukocytosis (WBC: 13630) and elevated CRP level (CRP: 9.3). Abdominal computed tomography (CT) scan revealed right prostate lobe enlargement with lobulated fluid collections, suspecting the presence of prostate abscess. The patient was then admitted for antibiotics therapy. Under relatively stable condition, the patient underwent transurethral resection of prostate (bipolar techinique) and suprapubic cystostomy (trocar method).

    After the operation, the pathology report showed malakoplakia. The postoperative clinical course was smooth. Foley catheter and cystostomy were indwelled with continuous normal saline irrigation. There was neither gross hematuria nor signs of infection. Foley catheter was subsequently removed on postoperative day 3, while the cystostomy was kept for voiding training. The patient was eventually discharged on postoperative day 5. During subsequent follow up, smooth self-voiding was mentioned and cystostomy was then removed on post-operative day 25. There was no recurrent infection or urinary retention experienced after the operation.

Discussion: 

    Malakoplakia is an inflammatory condition which primarily affects the genitourinary tract especially the urinary bladder. It may also occur in the lung, skin, uterus and the gastrointestinal tract. This uncommon inflammatory disease has a high prevalence in the immunocompromised and the females. Lower urinary tract symptoms and urinary retention are usually the initial symptoms experienced in prostatic malakoplakia patients. Imaging examinations which include the transrectal ultrasonography (TRUS), CT or magnetic resonance imaging (MRI) are unable to differentiate malakoplakia from malignancy. The final diagnosis of malakoplakia requires histopathological examination. There is currently no consensus on the treatment of malakoplakia. Various management of malakoplakia in related literatures includes the use of systemic antibiotic, surgical excision and discontinuation of immunosuppression drugs.

Conclusions: