Malakoplakia of the urinary tract is a granulomatous inflammatory disease due to bacterial infection and can usually be treated conservatively, whereas all of the past reported patients with solitary ureteral malakoplakia underwent surgical excision. We report a patient with solitary isolated upper ureteral malakoplakia that was successfully diagnosed by ureteroscopic biopsy. After conservative treatment with levofloxacin, bethanechol chloride and ascorbic acid, her right hydronephrosis and the lesion were reduced for more than six months.