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J Mol Biol 2019 10 17;431(21):4368-4379. Epub 2019 Apr 17.

Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. Electronic address:

Urinary tract infections (UTIs) are the most commonly reported infections in adult women and have high rates of recurrence, especially in postmenopausal women. Recurrent UTI (RUTI) greatly reduces quality of life, places a significant burden on the healthcare system, and contributes to antimicrobial resistance. Because treatment of RUTI by long-term antibiotic therapy is often ineffective or poorly tolerated in elderly women, new therapies must be developed. Read More

Low Urin Tract Symptoms 2019 Sep 15;11(4):182-188. Epub 2019 Apr 15.

Urology Department, UT Southwestern Medical Center, Dallas, Texas.

To consolidate our understanding of "trigonitis" and its relevance in current urologic practice, we reviewed the literature on this entity. The MEDLINE, EMBASE, and Cochrane databases (1905 to present) were systematically reviewed for any English language articles addressing the following terms: trigonitis, cystitis trigoni, cystitis cystica, squamous metaplasia, pseudomembranous trigonitis, vaginal metaplasia, infection or inflammation of the trigone, and trigonitis in recurrent urinary tract infections (rUTI). Abstracts or articles not focused on trigonitis, or those only repeating findings from other original articles on trigonitis, and studies in children or men were excluded. Read More

Int J Urol 2019 06 3;26(6):662-668. Epub 2019 Apr 3.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objective: To evaluate the long-term efficacy of electrofulguration in women with recurrent urinary tract infections.

Methods: After institutional review board approval, a retrospective study of women who underwent electrofulguration alone was carried out. All patients had recurrent urinary tract infections defined as three or more urinary tract infections/year, and a preoperative office cystoscopy showing inflammatory lesions, categorized by location: urethra, bladder neck, trigone and beyond the trigone. Read More

Urology 2018 03 28;113:26-33. Epub 2017 Nov 28.

University of Texas at Southwestern Medical Center, Dallas, TX. Electronic address:

Objectives: To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice.

Methods: A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known drug allergies, renal function, antibiotic susceptibility of most recent urine culture, allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and nitrofurantoin were obtained. Read More

J Urol 2016 Aug 13;196(2):422-8. Epub 2016 Feb 13.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

Purpose: We compared the rates of upper tract imaging abnormalities of recurrent urinary tract infections due to bacterial persistence or reinfection.

Materials And Methods: Following institutional review board approval we reviewed a prospectively maintained database of women with documented recurrent urinary tract infections (3 or more per year) and trigonitis. We searched for demographic data, urine culture findings and findings on radiology interpreted upper tract imaging, including renal ultrasound, computerized tomography or excretory urogram. Read More

Minerva Urol Nefrol 2014 Dec 18;66(4):225-32. Epub 2014 Jul 18.

Unit of Urology, Uroresearch Association Department of Sciences and Medico‑Surgical Biotechnologies Sapienza University of Rome I.C.O.T. Hospital, Latina, Italy -

Aim: The aim of the study was to compare Cistiquer, a new phytotherapeutic product developed for chronic bladder inflammatory diseases, and intra-vesical administration of gentamicin plus betametasone, in females with urethral syndrome.

Methods: Between september 2013 and may 2014, 60 women with urethral syndrome and trigonitis were incuded in this study. Patients were randomly assigned to treatment with intra-vesical administration of betametasone 8 mg plus gentamicin 80 mg (group A), and oral administration of Cistiquer (group B) for 7 weeks. Read More

Int J Clin Exp Pathol 2014 26;7(6):3375-9. Epub 2014 May 26.

Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital Singapore.

Klinefelter syndrome is a clinical syndrome with a distinct 47, XXY karyotype. Patients are characterized by a tall eunuchoid stature, small testes, hypergonotrophic hypogonadism, gynecomastia, learning difficulties and infertility. These patients have also been found to have raised estrogen levels. Read More

Acta Chir Iugosl 2011 ;58(3):77-9

Clinic of Urology, Clinical Center of Serbia, Beograd, Serbia.

The investigation of women with SUI the Serbian urologist traditionally begins with cystoscopy to reduced risk of bladder tumor. There is no doubt regarding its ability to detect bladder cancer presented with characteristic symptoms or pathologic results of urinalyses. We discuss its routine use in patients presenting with symptomatology of SUI. Read More

Urol Int 2006 ;76(2):134-8

Urology Department, University of Perugia, Perugia, Italy.

Introduction: The urethral syndrome is characterized by irritative disturbances, the urgency-frequency syndrome and/or pain associated with negative urine cultures. Areas of metaplasic tissue in the trigonal-bladder neck region (trigonitis) are sometimes present. We performed a comparative randomized study to assess the efficacy of side- or end-firing neodymium (Nd):YAG laser surgery in destroying metaplasia and relieving symptoms. Read More

Int J Urol 2003 Jan;10(1):36-42

Department of Urology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.

Background: Transabdominal ultrasonography was used to study the bladder neck morphology in women with urethral syndrome or stress urinary incontinence, in order to determine the ultrasonographic findings of these conditions.

Methods: A total of 210 female patients with a normal bladder, asymptomatic trigonitis, urethral syndrome, and stress incontinence were studied. The mucosal thickness around the bladder neck, the length of the anterior base plate of the bladder, and the anteroposterior vesical wall angle (APVA) at the bladder neck were measured on sagittal transabdominal vesical ultrasonograms with the patient in the supine position. Read More

Saudi Med J 2001 Sep;22(9):769-70

Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.

Objective: To study the laparoscopic and cystoscopic findings in women with chronic pelvic pain referred to the Gynecology Clinic at Sultan Qaboos University Hospital.

Methods: Women referred to Sultan Qaboos University Hospital, Sultanate of Oman from October 1998-September 2000 with pelvic pain of more than 6 months duration were clinically evaluated. Laparoscopic examination was always combined with cystoscopy. Read More

J La State Med Soc 1999 Aug;151(8):414-9

Department of Urogynecology and Pelvic Reconstructive Surgery, Omega Institute of Health, Metairie, La., USA.

This paper alerts physicians, health care workers, and employers to a probable connection between voluntary, infrequent voiding and urinary dysfunction. The dysfunction includes abnormal uroflow patterns, increased urethral resistance, abnormal post-void residuals, chronic trigonitis, and urethrovesical inflammatory polyps. A review of intermittent uroflow and obstructive uroflow patterns reveals that all females in this study worked long hours without voiding. Read More

Ann Hematol 1999 Apr;78(4):189-91

Department of Medicine I, University of Vienna, Austria.

Multiple myeloma with IgG-lambda monoclonal gammopathy and severe renal impairment with light-chain deposit disease was diagnosed in a 51-year-old man. Following conventional therapy with VAD (vincristine, adriamycin, dexamethasone) a partial remission was achieved. Peripheral blood stem cells (PBSC) were then collected following mobilization with cyclophosphamide and recombinant human granulocyte colony-stimulating factor and enriched for CD34-positive cells by immunoaffinity column. Read More

Actas Urol Esp 1994 Jan;18(1):69-75

Unidad de Urología del Sector de Granollers, ICS-Barcelona.

Subsequent to a certain amount of aggression, the vesical epithelium can induce some histological changes which would range from the most innocent morphological vicarious forms to the most aggressive neoplastic types (transitional, squamous and/or glandular tumours). Co-existence in the same urothelium of metaplastic, dysplastic and/or neoplastic lesions should not therefore be a surprise. With the intention of assessing the urothelium evolutive potential, we present a morphological study of the male cervix-trigonal epithelium abnormally involved in the steroidal hormones immunosuppression and actions. Read More

J Endocrinol Invest 1992 Nov;15(10):719-25

Dipartimento di Scienze Biomediche e Oncologia Umana, University of Torino, Italy.

According to recent studies showing the presence of estrogens receptors (ERs) in the human female lower urinary tract, we performed ER and progesterone receptor (PR) assays in fresh frozen and paraffin embedded biopsies taken from the urinary bladder. Fourteen females undergoing endoscopy during staging for gynecological cancer (endometrium, cervix, ovary) and 15 women complaining of recurrent abacterial cystitis (pseudomembranous trigonitis) were enrolled in the study as Group 1 and Group 2, respectively. After informed consent, they were submitted to cystoscopy, during which two biopsies were taken: one on the trigonum and the other on the bladder lateral wall. Read More

Nihon Hinyokika Gakkai Zasshi 1992 Jul;83(7):1094-100

Department of Urology, Akita University School of Medicine.

Transabdominal ultrasonography of the bladder and internal examination were performed in 80 female patients without pyuria. They were divided into 3 groups: urethral syndrome with trigonitis (49 cases), asymptomatic trigonitis (16 cases) and normal bladder (15 cases) by cystoscopy. Ultrasonography of trigonitis with or without symptoms showed focal dilation of the submucosal low echo zone and mucosal irregularity around the bladder neck. Read More

Acta Urol Belg 1992 ;60(1):73-5

Urologic Pathology-University of Pisa.

Sensory disorders of the lower urinary tract (urethral syndrome, prostatodynia, painful pelvic-perineal syndromes, trigonitis) are clinically frequent, however this diagnosis is possible only by excluding other pathologies after clinical and instrumental evaluation. The Authors report their experience in urodynamic evaluation of sensory disorders of the lower urinary tract and they discuss about the absence of a typical urodynamic pattern of sensorial pathology. Read More

Br J Urol 1989 Nov;64(5):472-7

Department of Cell and Structural Biology, University of Manchester.

The present investigation provides a histological and fine structural description of pseudomembranous trigonitis, an ill-understood metaplastic condition affecting particularly the female trigone. Normal trigonal urothelium consists of 3 cell layers (basal, intermediate and superficial), whereas pseudomembranous trigonitis constitutes many layers of stratified squamous epithelium. The basal cells contain prominent nuclei with condensed chromatin, nucleoli and nuclear bodies. Read More

J Clin Pathol 1989 Sep;42(9):922-6

Department of Pathology, University of Sheffield Medical School.

Fourteen formalin fixed and paraffin wax embedded biopsy specimens from 10 women (age range 34-68) presenting with pseudomembranous trigonitis were studied using a combination of anti-oestrogen receptor monoclonal antibodies in an avidin-biotin immunoperoxidase technique. All epithelial areas showing vaginal metaplasia exhibited staining confined to the nucleus in the basal and parabasal layers of the squamous epithelium while no staining was encountered in adjacent trigonal transitional epithelium included in nine of the biopsy specimens. The selective expression of nuclear oestrogen receptor in trigonal epithelium affected by vaginal metaplasia in a distribution similar to that reported in vaginal epithelium by other workers lends further support to oestrogen mediated aetiology in this condition and is consistent with an embryological derivation of the trigone, distinct from that of the rest of the bladder. Read More

Actas Urol Esp 1988 May-Jun;12(3):202-3

Br J Urol 1985 Oct;57(5):552-6

Thirty-one women with the recurrent urethral syndrome (abacterial cystitis) had extensive microbiological, cytological and histological investigations. A Streptococcus species was isolated from the bladder aspirate of one patient, a wall-deficient Streptococcus species from two others and both a Lactobacillus species and Ureaplasma urealyticum from another. A possible microbiological cause was therefore identified in the bladder in only 4 of the 31 patients. Read More

Clin Ter 1985 Aug;114(4):323-30

Ginecol Obstet Mex 1978 Dec;44(266):459-62

The results of 350 cystoscopic studies, are presented. In 85.7%, urinary incontinence was present, and in 72% one or more of the following symptoms were present: urgency, dysuria, urinary frequency, vesical tenesmus and nycturia. Read More

Urology 1978 Mar;11(3):215-20

Intravesical dimethyl sulfoxide (DMSO) has been used in the treatment of 213 patients with various inflammatory conditions involving the lower genitourinary tract, including intractable interstitial cystitis, radiation cystitis, chronic prostatitis, and chronic female trigonitis. Significant symptomatic relief has been achieved in the majority of patients so treated, and no systemic or local toxicity has been noted. Some patients failed to respond entirely, and others relapsed after DMSO treatment periods of several months, ultimately coming to augmentation cystoplasty or urinary diversion. Read More

Postgrad Med 1977 Sep;62(3):73-9

There is a definite place for estrogen replacement in symptomatic menopausal women. Requisites of such therapy are a through history to establish a real need, a complete gynecologic examination with a Pap smear before therapy begins and annually afterward, use of the smallest daily dose of estrogen that gives the desired effect, and periodic attempts to reduce the dosage or stop the hormone. Endometrial biopsy should be done regularly if this is feasible, and any uterine bleeding should be investigated. Read More

Aust Fam Physician 1977 Jan;6(1):17-8, 21, 25 PASSIM

The major urological problems encountered in geriatric patients are bladder neck obstruction, due to hyperplasia or carcinoma of the prostate in men, and urinary infection and chronic urethro-trigonitis (the urethral syndrome) in women. Senile incontinence is common to both sexes. Read More

Urology 1975 May;5(5):612-5

In nine separate clinical trials, 382 patients having symptoms of either prostatitis, acute cystitis, urethritis, and/or trigonitis were randomly assigned to treatment with flavoxate or phenazopyridine. Over-all response was evaluated in 384 patients after five days of therapy. In patients having prostatitis, response was satisfactory in 66 per cent treated with flavoxate and 31 per cent treated with phenazopyridine. Read More

J Clin Pathol 1971 Oct;24(7):605-8

Pseudomembranous trigonitis presents in females with the urethral syndrome and a characteristic lesion restricted to the trigone of the bladder. The histology shows ;vaginal metaplasia' of the epithelium together with underlying oedema and vascular dilatation, but no significant inflammation. Thirty-one such cases are included in the study. Read More

J Pathol 1970 Feb;100(2):P3

N Y State J Med 1961 Aug;61:2598-602

Br Med J 1956 Sep;2(4994):696-7

Calif Med 1954 May;80(5):380-1

Cortisone was instilled into the bladder in the treatment of interstitial cystitis and contracted bladder, trigonitis and urethritis in females, nonspecific urethritis in males, and inflammation of the wall of the bladder. In infectious cases the hormonal therapy was used after antibacterial measures had failed. Improvement occurred quickly in most cases soon after cortisone therapy was given. Read More

G Ital Chir 1953 Oct;9(10):770-8

Stanford Med Bull 1953 Feb;11(1):61-4

S Afr Med J 1952 Aug;26(32):655-7

J Urol 1951 Apr;65(4):684-7

Pa Med J 1950 May;53(5):489-93

Calif Med 1949 Aug;71(2):126-9

The most frequent postoperative urinary problem after various types of general operations is urinary retention. It may be due to previously unrecognized dynamic obstruction, but is more often psychogenic or due to a temporary disturbance in function of the sympathetic and parasympathetic nervous systems. Catheterization may be done safely as a means of preventing over-distention of the bladder. Read More

Med Press 1948 Nov;220(18):365

J Urol 1947 Jun;57(6):1028-37

Urol Cutaneous Rev 1947 Feb;51(2):82-4

Br J Urol 1946 Dec;18(4):189-95

Ann Surg 1935 Jan;101(1):594-8