V07-12 FULGURATION FOR PANCYSTITIS CYSTICA (STAGE 4) IN WOMEN WITH RECURRENT URINARY TRACT INFECTIONS

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You have accessJournal of UrologyCME1 Apr 2023V07-12 FULGURATION FOR PANCYSTITIS CYSTICA (STAGE 4) IN WOMEN WITH RECURRENT URINARY TRACT INFECTIONS Philippe E. Zimmern, Colby P. Souders, Jessie Chen, and Ramy Goueli Philippe E. ZimmernPhilippe E. Zimmern More articles by this author , Colby P. SoudersColby P. Souders More articles by this author , Jessie ChenJessie Chen More articles by this author , and Ramy GoueliRamy Goueli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This movie describes our experience with recurrent urinary tract infections in postmenopausal women who have very extensive lesions of cystitis cystica in their bladder. METHODS: As shown in this diagram of the bladder, a simple staging system was devised to account for the visual extent of cystitis lesions noted on cystoscopy. Stage 1 is just for lesions covering the trigone or trigonitis. Stage 2 includes stage 1 and extension of these lesions to the bladder base. Stage 3 involves stage 2 as well as lesions lateral to the ureteric orifices on one or both sides, and finally Stage 4 is for a complete bladder involvement with stage 3 lesions also extending to the posterior wall, dome, anterior area. This condition is sometimes referred as pancystitis. RESULTS: Here are typical lesions of cystitis cystica noted over the trigone and bladder base, and extending laterally and anteriorly in a patient with antibiotic-recalcitrant recurrent urinary tract infections. We used a small tip bugbee electrode on a low setting under anesthesia on an outpatient basis. We started the procedure by marking around the ureteric orifices to easily recognize their location and protect them. Then we focus on lesions at the dome and anteriorly. One can see here the white pods representing the bacterial infection niches beneath the fulgurated surface mucosa. Fulguration can literally explode or “pop” these niches and drain out these pod collections. Here is a survey of a bladder with pancystitis following extensive fulguration. The ureteric orifices are identified and are still effluxing urine well. On this second patient, a similar pattern of extensive pancystitis can be observed. Due to recurrent infections, that same patient underwent a second fulguration one year later. At that time, healed areas from the first fulguration were noted with a shallow, white or light pink, appearance, and few areas of cystitis cystica were seen interspersed in between and targeted during this repeat fulguration procedure. CONCLUSIONS: Women with antibiotic-recalcitrant symptomatic and uncomplicated recurrent urinary tract infections with stage 4 or pancystitis, who have very few options left for therapy short of undergoing a cystectomy, can benefit at times from fulguration even though the procedure is longer than in an earlier stage, can take longer to recover from, and may not be as successful than in an early stage with lesions just confined to the trigone and/or bladder base. Therefore, our experience invites considering early cystoscopy in the evaluation of women suffering from recurrent urinary tract infections to detect these lesions at a low volume of surface disease. Ma R, Chavez JA, Christie AL, Zimmern PE. Electro-fulguration for extensive inflammatory bladder lesions in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Int Urogynecol J. 2022 Sep 27. doi: 10.1007/s00192-022-05360-w. Epub ahead of print. PMID: 36166061. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e599 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe E. Zimmern More articles by this author Colby P. Souders More articles by this author Jessie Chen More articles by this author Ramy Goueli More articles by this author Expand All Advertisement PDF downloadLoading ...