Introduction and Objective Recurrent urinary tract infections (R‐UTIs) have a negative impact on quality of life and contribute to antimicrobial resistance. Long‐term antibiotic therapy is the main treatment alternative but, in some cases, this approach may not be accepted by the patient, is ineffective or poorly tolerated. In selected women, electrofulguration (EF) of trigonal lesions has been shown to reduce urinary tract infection (UTI) episodes. Methods Between August 2006 and December 2017, 73 women with R‐UTI had their data collected prospectively and analyzed. We evaluated the rate of UTIs during the initial 2 years of follow‐up after fulguration based on symptoms and a positive urine culture. All patients failed with multiple antibiotic courses and were offered endoscopic electrofulguration of the entire trigonal and bladder neck mucosa with a rollerball probe. We present our long‐term results using a strategy of complete fulguration of the trigone in women with R‐UTIs. Results The median age was 64 years (range: 17–76 years) and the median follow‐up time after EF was 4.2 years (range: 2.5–14 years). Overall, 70 patients (96%) remained free of UTI episodes during the first year of follow‐up, at 2 years of follow‐up, 57, 53% remained infection‐free. Currently, UTIs are 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 2 years of follow‐up. Prospective controlled studies are needed to determine the role of EF in women with R‐UTI.

Objective Chronic trigonitis (CT) is usually diagnosed through cystoscopy which is invasive and expensive. Thus, an accurate non‐invasive diagnostic method is necessary. The objective of this study is to determine the efficacy of transvaginal bladder ultrasound (TBU) for CT diagnosis. Methods Between 2012 and 2021, 114 women (17–76 years old) with recurrent urinary tract infection (RUTI) and history of antibiotic resistance were evaluated with TBU by a single ultrasonographer. As a control group, TBU was performed in 25 age‐matched women with no previous history of UTI, urological or gynecological conditions. All patients with RUTI had undergone a cystoscopy with biopsy for diagnostic confirmation at the time of trigone cauterization. Results Thickening of trigone mucosa (>3 mm) was detected in all patients with RUTI and represented the most relevant criteria for trigonitis diagnosis on TBU. Other TBU findings in CT are: irregular and interrupted mucosa lining (96.4%), free debris in the urine (85.9%), increased blood flow at doppler (81.5%), mucosa shedding and tissue flaps. Biopsy showed CT with erosive pattern (58%) or non‐keratinizing metaplasia (42%). Diagnostic agreement index between TBU and cystoscopy was 100%. In the control group, normal trigone mucosa is ultrasonographically regular, continuous, with thickness ≤3 mm and there is no debris in the urine. Conclusions TBU proved to be an efficient, inexpensive and minimally invasive method to diagnose CT. To our knowledge, this is the first article that reports the use of transvaginal ultrasound as an alternative method for diagnosing trigonitis.

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