#23018
Electrofulguration of trigonitis in the management of recurrent urinary tract infections in women
Zimmern P1, Stevens J1, Crivelli J1, Souders C1, Goueli R1
1. U.T. Southwestern Medical Center
KEYWORDS: Infection, Urinary Tract, Surgery, Female
Endoscopic fulguration of the trigone, also called endoscopic diathermy, has been around for a long time to treat chronic painful bladder lesions, as sometimes seen in women suffering from interstitial cystitis. Although known from pelvic floor surgeons, there is a dearth of reports on the use of this technique in the management of recurrent urinary tract infections (RUTIS) in women.
After a thorough evaluation of these patients to exclude upper and lower urinary tract pathologies, including pelvic examination, renal ultrasound, voiding cystogram, cystoscopy, and basic voiding parameters (flow and postvoid residual), has been completed and returned negative, in those with antibiotic-refractory RUTIs who have chronic trigonitis recognized on office-based cystoscopy, we have proceeded with electrofulguration of the trigonitis area [1]. Additional work from our group on bladder biopsies of these areas before fulguration has been reported and showed resident bacteria deep in the tissues, suggesting that the mechanism for recurrence is internal and not via a urethral ascending mechanism in these women [2].
This movie describes our endoscopic fulguration technique in a representative patient.