eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Trigonitis

Author: Scott Rutchik, MD, Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine
Contributor Information and Disclosures

Updated: May 13, 2009

Introduction

Background

Trigonitis describes the apparent squamous metaplastic changes that occur in the trigone of the bladder (see Image 1). These changes are much more common in adult females. Heymann first described the lesion in 1905 as cystitis trigoni.1 Subsequently, Cifuentes described the condition as a true trigonal membrane.2

Trigonitis.

Trigonitis.

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Trigonitis.

Trigonitis.

Pathophysiology

The trigone of the bladder (as well as the ureters) are embryologically derived from the mesonephric duct primordia. Normally, this area of the bladder is covered in relatively impermeable transitional epithelium.

In young females, there may be an overgrowth of squamous vaginal-type epithelium, a condition often referred to as trigonitis. In this setting, trigonitis is incorrect terminology because no associated inflammatory reaction exists. This condition is referred to more properly as trigonal nonkeratinizing squamous metaplasia.

Mortality/Morbidity

This condition has minimal morbidity or mortality unless it evolves into frank squamous carcinoma.

Sex

  • Squamous metaplastic changes of the trigone are observed in as many as 40% of adult women.
  • Similar lesions are much less common in men, with an observed frequency of only 5%.

Age

Squamous metaplasia of the trigone occurs almost exclusively in women of childbearing age. It is almost nonexistent in children.

Clinical

Physical

  • Simple physical examination probably will not identify this lesion.
  • The diagnosis is confirmed by cystoscopic examination of a white patch of tissue in the bladder trigone.

Causes

  • The causes of squamous trigonal metaplasia are unclear.
  • In the classic nonkeratinizing lesion observed in younger females, the etiology may be secondary to vaginal epithelial overgrowth of the trigone.
  • The keratinizing variant frequently is associated with chronic irritation secondary to indwelling instrumentation, calculi, or, in endemic areas, Schistosoma haematobium infection.

More on Trigonitis

Overview: Trigonitis
Differential Diagnoses & Workup: Trigonitis
Treatment & Medication: Trigonitis
Follow-up: Trigonitis
Multimedia: Trigonitis
References
Further Reading
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References

  1. Heymann A. Die cystitis trigoni der frau. Zentralbl Kr Harn Sex. 1905;16:422-33.

  2. Cifuentes L. Epithelium of vaginal type in the female trigone: the clinical problem of trigonitis. J Urol. 1947;57:1028-37.

  3. Neimark AI, Vasil'chenko SI, Il'inskaia EV, Taranina TS, Lebedeva RN, Isachenko SI, et al. [Special features of chronic cystitis with leukoplasional changes of a mucous environment women's urinary bladder]. Voen Med Zh. Jun 2007;328(6):58-61. [Medline].

  4. Sugaya K, Nishijima S, Oda M, et al. Transabdominal vesical sonography of urethral syndrome and stress incontinence. Int J Urol. Jan 2003;10(1):36-42. [Medline].

  5. Benson RC Jr, Swanson SK, Farrow GM. Relationship of leukoplakia to urothelial malignancy. J Urol. Mar 1984;131(3):507-11. [Medline].

  6. Henry L, Fox M. Histological findings in pseudomembranous trigonitis. J Clin Pathol. Oct 1971;24(7):605-8. [Medline].

  7. Jost SP, Gosling JA, Dixon JS. The fine structure of human pseudomembranous trigonitis. Br J Urol. Nov 1989;64(5):472-7. [Medline].

  8. Locke JR, Hill DE, Walzer Y. Incidence of squamous cell carcinoma in patients with long-term catheter drainage. J Urol. Jun 1985;133(6):1034-5. [Medline].

  9. Long ED, Shepherd RT. The incidence and significance of vaginal metaplasia of the bladder trigone in adult women. Br J Urol. Apr 1983;55(2):189-94. [Medline].

  10. Mueller SC, Thueroff JW, Rumpelt HJ. Urothelial leukoplakia: new aspects of etiology and therapy. J Urol. May 1987;137(5):979-83. [Medline].

  11. Murphy WM. Diseases of the urinary bladder, urethra, ureters, and renal pelves: squamous metaplasia. Urological Pathology. 1997;60-2.

  12. Tyler DE. Stratified squamous epithelium in the vesicle trigone and urethra: findings correlated with menstrual cycle and age. Am J Anat. 1962;111:319-25.

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Further Reading

Clinical guidelines

ACR Appropriateness Criteria® recurrent lower urinary tract infections in women.
American College of Radiology - Medical Specialty Society. 1995 (revised 2005). 6 pages. [NGC Update Pending] NGC:004608

Referral guidelines for suspected cancer in adults and children.
National Collaborating Centre for Primary Care - National Government Agency [Non-U.S.]. 2005 Jun. 791 pages. NGC:004465

Clinical trials

Evaluation of Non-Invasive Assay(s) for the Detection of Bladder Cancer

Quantitative and Qualitative Changes in Neural Efferent Receptors

Quality of Life and Symptom Management in Patients With Bladder Cancer

Related eMedicine topics

Urinary Tract Infection, Females

Urethral Syndrome

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Keywords

trigonal squamous metaplasia, pseudomembranous trigonitis, bladder leukoplakia, bladder cancer, cystitis trigoni, true trigonal membrane, trigonal nonkeratinizing squamous metaplasia, trigone leukoplakia, trigonal leukoplakia, squamous trigonal metaplasia, bladder disorder, trigone disorder

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Contributor Information and Disclosures

Author

Scott Rutchik, MD, Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine
Scott Rutchik, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Leonard Gabriel Gomella, MD, FACS, The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Thomas Jefferson University
Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology
Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

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