Trigonitis Treatment & Management

Updated: Aug 24, 2020
  • Author: Wellman W Cheung, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Treatment

Approach Considerations

Asymptomatic patients do not require treatment for trigonitis. A urologist may be consulted in symptomatic cases. Several treatment approaches have been tried in patients with symptomatic trigonitis, including medications and surgery. Because it presents a constant source of irritation, long-term indwelling instrumentation of the bladder should be discouraged if better alternatives for bladder drainage are feasible.

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Medical Care

Antibiotic therapy with a course of doxycycline proved effective in a study of 103 women with cystoscopically confirmed trigonitis and irritative voiding symptoms. In addition to vaginal tablets to eradicate microbial reservoirs, the women received doxycycline at 100 mg twice daily for 2 weeks, followed by 100 mg daily for 2 weeks. Sexual partners were also treated with doxycycline 100 mg twice daily for 2 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. On follow-up cystoscopy in 31 patients, trigonitis was completely resolved in 8 cases and improved in 12 cases. [19]

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

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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. [20]

In a retrospective study of 33 women with longstanding recurrent UTIs refractory to antibiotic treatment who underwent cystoscopy with fulguration of trigonitis (CFT), 76% had a complete cystoscopic resolution of the trigonal lesions at 6 months postoperatively. The patients with complete resolution had a significantly decreased need for antibiotic treatment for UTI-related symptoms and/or positive urine cultures, compared with the group with residual trigonitis following CFT. [21]  

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