Figure 9-2.3. Vestibulectomy technique: The vaginal mucosa is dissected free.
Trigonitis is inflammation localized to the bladder trigone. Symptoms manifest as bladder and urethral pain, as well as frequency and nocturia. Digital palpation will reveal pain localized to the trigone.
Acute trigonitis is usually obvious on cystoscopy and may be treated with a routine course of antibiotics. Chronic trigonitis is typically more subtle with mild inflammatory surface changes. Abundant squamous metaplasia, common to this tissue, is often mistaken for inflammation by the inexperienced cystoscopist.
Chronic trigonitis is often preceded by recurrent, documented urinary tract infections and is thought to represent a deep tissue bacterial infection. A long course of antibiotics with good tissue penetration is indicated as first-line therapy. We use Vibramycin 100 mg twice a day for 21 days. If antimicrobial therapy is unsuccessful, the patient should be evaluated and treated for interstitial cystitis.
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