MP25-13 EXPERIENCE WITH COMPLETE TRIGONAL ELECTROFULGURATION FOR WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: TWO YEARS FOLLOW-UP

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021MP25-13 EXPERIENCE WITH COMPLETE TRIGONAL ELECTROFULGURATION FOR WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: TWO YEARS FOLLOW-UP Leopoldo Ribeiro-Filho, Felipe Hirasaki, Eduardo Miranda, Matheus Siqueira, Cristiano Gomes, Miguel Srougi, and William Nahas Leopoldo Ribeiro-FilhoLeopoldo Ribeiro-Filho More articles by this author , Felipe HirasakiFelipe Hirasaki More articles by this author , Eduardo MirandaEduardo Miranda More articles by this author , Matheus SiqueiraMatheus Siqueira More articles by this author , Cristiano GomesCristiano Gomes More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and William NahasWilliam Nahas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002022.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent urinary tract infections (RUTI) have a negative impact on quality of life, contribute to antimicrobial resistance and have a significant economic burden. Long-term antibiotic therapy is the main treatment alternative but is often ineffective or poorly tolerated. In selected women, electrofulguration (EF) of trigonal lesions has been shown to reduce UTI episodes. In this study we evaluated the efficacy of complete trigonal EF for women with RUTI. METHODS: Between August 2006 and December 2017, 73 women with RUTI defined as three or more episodes of UTI per year were included in the study and completed at least two years of follow-up. All had undergone proper evaluation to exclude common causes of RUTI and all had squamous metaplasia and/or inflammatory lesions of the trigone or bladder neck. All had failed multiple antibiotic courses and were offered trigonal electrofulguration. Under anesthesia, endoscopic electrofulguration of the entire trigonal and bladder neck mucosa was performed using a roller ball. Biopsies were obtained prior to fulguration for histopathology analysis and in situ hybridization for Human Papiloma Virus (HPV). Patients were maintained on continuous bladder irrigation for a few hours and discharged home with no indwelling catheter. We evaluated the rate of UTIs during the initial two years of followup after fulguration based on symptoms and a positive urine culture. RESULTS: The median age was 64 years (range 17–76) and the median follow-up time after EF was 4.2 years (range 2.5 to 14 years). The procedure was well tolerated by all patients. Adverse events, most frequently disuria were mild and transient. In 24/76 (33%) patients bladder lesions in areas other than the trigone and bladder neck were also fulgurated. Histologically, squamous metaplasia (SM) was found in 31 (42%) patients and chronic erosive trigonitis (ET) in 42 (58%). HPV in situ hybridization was positive in 4/31 (13%) patients in the SM group and none in the ET group. Overall, 70/76 (96%) patients remained free of UTI episodes during the first year of follow-up, including 29/31 (94%) in the SM group and 41/42 (98%) in the ET group. At 2 years of follow-up, 15/31 (48%) in the SM group remained infection-free vs 27/42 (64%) in the ET group .UTIs were typically sparse, mild and caused by multisensitive bacteria. CONCLUSIONS: Complete trigonal and bladder neck mucosal fulguration promoted a significant reduction of UTI episodes during the first two years of follow-up. Prospective controlled studies are needed to determine the role of EF in women with RUTI. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e458-e458 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leopoldo Ribeiro-Filho More articles by this author Felipe Hirasaki More articles by this author Eduardo Miranda More articles by this author Matheus Siqueira More articles by this author Cristiano Gomes More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Expand All Advertisement Loading ...