Holmium:YAG Laser Coagulation in the Female Patients of Voiding Symptom with Pseudomembranous Trigonitis

ABSTRACT

PURPOSE: Pseudomembranous trigonitis is a common cystoscopic finding in the female patients with voiding symptoms. We evaluated the changes in voiding symptoms of the patients after coagulating this lesion with Holmium:YAG laser. MATERIALS AND METHODS: Six female patients with voiding symptoms including frequency, dysuria, lower abdominal pain who were refractory to the conservative treatment for more than 1 month were enrolled in this study. The mean age was 35(range: 26~43) years. The patients were treated with cystoscopic evaluation and Holmium:YAG laser with 365 and 500 micrometer probe fibers. Power setting was between 6 and 11 watts. Only the lesions at the trigone and bladder neck were coagulated. No indwelling urethral catheter was used postoperatively. We evaluated patient's symptoms with out-patient follow-up or telephone up to 16 months. RESULTS: The mean duration of symptoms were 3.8(range: 6 months~13 years) years, and the mean follow-up was 13.3(range: 8~16) months. In all cystoscopic evaluations, pseudomembranous trigonitis was seen. After treatment, 3 of the 6 patients showed symptomatic improvements within 3 months and retained the improved state up to the last follow-up period. However, in the other 3 patients, no change in symptoms or initial response with following recurrence was seen. In the 3 patients who showed good response, transient worsening period of 1~3 months preceded the improvement. Follow-up cystoscopy at 3 months showed complete regeneration of the trigone and bladder neck mucosa. CONCLUSION: In the patients of pseudomembranous trigonitis with voiding symptoms refractory to conservative therapy, laser coaulation of the trigonal lesion was not so satisfactory but may be one of therapeutic options. Further investigation is needed.