Long-term efficacy of fulguration of trigonitis for recurrent urinary tract infections in women

Objective: Women with a longstanding history of recurrent urinary tract infections (RUTIs) represent a challenging population because of gradual development of antibiotic resistance and frequent antibiotic allergies. We report on the long-term results of women with RUTIs and trigonitis who were treated using endoscopic fulguration and were prospectively followed. Materials and methods: Following institutional review board approval, charts of non-neurogenic women with RUTIs (defined as ≥3 UTIs/y), no voiding dysfunction or incontinence, and normal upper tracts by imaging, who underwent cystoscopy with fulguration of trigonitis (CFT) under anesthesia with 1 year minimum follow up after CFT, were reviewed. Trigonitis was defined as a condition of inflammation of the trigone region of the bladder. The primary outcome was complete resolution of trigonitis based on follow-up office cystoscopy 6 months after CFT. The secondary outcome was the total number of antibiotic courses (AC) prescribed for UTI-related symptoms and/or positive urine cultures (PUC) following CFT. We hypothesized that patients with complete trigonitis resolution after CFT fared best. Results: From 2004 to 2008, 33 women met the inclusion criteria with a mean follow up of 48 ± 19 months (range, 14-82 months). Resolution of trigonitis at 6 months was noted in 25 (76%) patients. This group averaged 0.51 ± 0.5 total AC and/or PUC/y compared with 2.03 ± 1.1 total AC and/or PUC/y for women with persistent trigonitis following CFT (p = 0.006). Conclusion: Patients with resolved trigonitis at 6 months after CFT did best; however, both groups benefited from the procedure over time.