4. Treatment
Several antibiotic regimens have been used to relieve lower
urinary tract symptoms in patients with pseudomembranous
trigonitis. Recently, Burkhard et al. [15] studied the efficacy
of doxycycline in 103 such patients. They received 100mg
doxycycline twice daily for 2 weeks, followed by 100mg once
daily for another 2 weeks. In 30% of the cases complete
response was recorded while 41% of the patients reported
improvement of the symptoms. In 8 of the 31 patients
that consented to followup cystoscopy pseudomembranous
trigonitis resolved completely while in 12 cases a decrease in
the degree of squamous metaplasia was revealed.
Recently, endoscopic treatment with the use of laser
fibers has been introduced. In a randomized prospective
study [16], 62 women with pseudomembranous trigonitis,
confirmed on biopsy, underwent treatment with either endfiring
(Group 1) or side-firing (Group 2) Nd:YAG laser
(energy setting: 30W). Results were significantly better
for the women of the first group (P < .001). Followup
cystoscopy and biopsies in symptom-free patients did not
reveal squamous metaplasia.
We are currently conducting a randomized prospective
comparative study between per os clarithromycin (500 mg
per day) and intravesical cystistat (40 mg of sodium
hyaluronate per week) in women with pseudomembranous
trigonitis. Sodium hyaluronate is a derivative of hyaluronic
acid that replaces the deficient glycosaminoglycan (GAG)
layer of the bladder wall. It is the traditional agent for GAG
substitution therapy based on existing theories about urothelial
dysfunction [17]. Sodium hyaluronate has been safely
administered with success for the treatment of chemical and
radiation cystitis as well as interstitial cystitis [18, 19]. In our
study patients are assessed with a validated symptoms score
questionnaire as well as with biopsies of the bladder trigone.
Relevant preliminary and followup results are warranted.
5. Epilogue
Although pseudomembranous trigonitis affects a large proportion
of female population, few patients seek medical
consultation and many are asymptomatic. Still, the true
meaning and cause of pseudomembranous trigonitis remain
elusive. The absence of an obvious causative factor makes
treatment difficult while the recent use of end-firing Nd:YAG
laser has demonstrated promising results.
Interestingly, the relevant literature upon pseudomembranous
trigonitis is extremely scant. Therefore, studies are
needed in order to understand better this very common but
underrecognized entity and provide adequate treatment.
References
[1] S. P. Jost, J. A. Gosling, and J. S. Dixon, “The fine structure
of human pseudomembranous trigonitis,” British Journal of
Urology, vol. 64, no. 5, pp. 472–477, 1989.
[2] A. Heymann, “Die cystitis trigoni der frau,” Zentralblatt fur die
Krankheiten derHahn und SexualOrgane, vol. 16, pp. 422–433,
1905.
[
Comment Reply
Some helpful info from medical findings.....
4. Treatment
December 11, 2011 - 11:28amSeveral antibiotic regimens have been used to relieve lower
urinary tract symptoms in patients with pseudomembranous
trigonitis. Recently, Burkhard et al. [15] studied the efficacy
of doxycycline in 103 such patients. They received 100mg
doxycycline twice daily for 2 weeks, followed by 100mg once
daily for another 2 weeks. In 30% of the cases complete
response was recorded while 41% of the patients reported
improvement of the symptoms. In 8 of the 31 patients
that consented to followup cystoscopy pseudomembranous
trigonitis resolved completely while in 12 cases a decrease in
the degree of squamous metaplasia was revealed.
Recently, endoscopic treatment with the use of laser
fibers has been introduced. In a randomized prospective
study [16], 62 women with pseudomembranous trigonitis,
confirmed on biopsy, underwent treatment with either endfiring
(Group 1) or side-firing (Group 2) Nd:YAG laser
(energy setting: 30W). Results were significantly better
for the women of the first group (P < .001). Followup
cystoscopy and biopsies in symptom-free patients did not
reveal squamous metaplasia.
We are currently conducting a randomized prospective
comparative study between per os clarithromycin (500 mg
per day) and intravesical cystistat (40 mg of sodium
hyaluronate per week) in women with pseudomembranous
trigonitis. Sodium hyaluronate is a derivative of hyaluronic
acid that replaces the deficient glycosaminoglycan (GAG)
layer of the bladder wall. It is the traditional agent for GAG
substitution therapy based on existing theories about urothelial
dysfunction [17]. Sodium hyaluronate has been safely
administered with success for the treatment of chemical and
radiation cystitis as well as interstitial cystitis [18, 19]. In our
study patients are assessed with a validated symptoms score
questionnaire as well as with biopsies of the bladder trigone.
Relevant preliminary and followup results are warranted.
5. Epilogue
Although pseudomembranous trigonitis affects a large proportion
of female population, few patients seek medical
consultation and many are asymptomatic. Still, the true
meaning and cause of pseudomembranous trigonitis remain
elusive. The absence of an obvious causative factor makes
treatment difficult while the recent use of end-firing Nd:YAG
laser has demonstrated promising results.
Interestingly, the relevant literature upon pseudomembranous
trigonitis is extremely scant. Therefore, studies are
needed in order to understand better this very common but
underrecognized entity and provide adequate treatment.
References
[1] S. P. Jost, J. A. Gosling, and J. S. Dixon, “The fine structure
of human pseudomembranous trigonitis,” British Journal of
Urology, vol. 64, no. 5, pp. 472–477, 1989.
[2] A. Heymann, “Die cystitis trigoni der frau,” Zentralblatt fur die
Krankheiten derHahn und SexualOrgane, vol. 16, pp. 422–433,
1905.
[
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