Trigonitis Treatment & Management

Updated: Apr 17, 2015
  • Author: Wellman W Cheung, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Treatment

Medical Care

Asymptomatic patients do not require treatment. Several approaches have been tried in patients with symptomatic trigonitis.

In one study of 103 women with persistent urinary frequency, chronic urethral and/or pelvic pain associated with dyspareunia, and/or a history of recurrent UTIs, all subjects were found to have trigonitis on cystoscopic examination. In additional to vaginal tablets to eradicate microbial reservoirs, subjects were treated with doxycycline at 100 mg twice daily for two weeks, followed by 100 mg daily for two weeks. Sexual partners were also treated with doxycycline 100 mg twice daily for two weeks, and the use of condoms was recommended during the entire treatment period. Following the treatment, 30% of patients considered themselves cured, and 41% reported symptom improvement. Of the 31 patients who consented to follow-up cystoscopy, 16 (52%) considered themselves cured or improved. Trigonitis was completely resolved in 8 of 31 cases and diminished in 12 of 31 cases. [17]

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Surgical Care

Endoscopic treatment with an Nd:YAG laser was attempted in women with urethral syndrome and biopsy-confirmed squamous metaplasia of the bladder refractory to medical treatment. Patients (n=62) were randomized to end-firing or side-firing Nd:YAG laser treatment at 30 W. Although results, as assessed by the Urogenital Distress Inventory short form (UDI-6), were significantly better in the side-firing group, follow-up cystoscopy and biopsy found that squamous metaplastic lesions were no longer present in patients of either group with symptom improvement, but white lesions in the bladder neck and trigone were seen in patients whose symptoms were unchanged or worsened. [18]

An ongoing randomized trial is comparing oral clarithromycin 500 mg daily and intravesical sodium hyaluronate instillation at 40 mg weekly (Cystistat) in patients with trigonitis in Europe. Sodium hyaluronate is a derivative of hyaluronic acid that replaces the deficient GAG layer in the bladder wall. [14] However, intravesical sodium hyaluronate is not currently approved by the US Food and Drug Administration (FDA).

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Consultations

A urologist may be consulted.

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