Trigonitis is a term denoting metaplastic changes in the bladder epithelium (conversion of transitional to squamous nonkeratinizing), and since its description at the beginning of the 20th century, very few reports exist in the literature [1] [2] [3]. Inflammatory events occurring in the bladder were initially assumed to be the main pathogenic stimulus for this epithelial change, and bacterial infections of the lower urinary tract (eg. cystitis) are considered as a possible risk factor for trigonitis [1]. It was subsequently confirmed, however, that the effect of estrogens on the bladder epithelium is the principal mechanism of this change [1] [3]. Consequently, trigonitis is almost always diagnosed in females of childbearing age, as only six male cases have been reported [1] [4] so far. The main symptoms are frequent micturition and a sense of urgency [1] [2]. Moreover, studies have identified that the presence of pelvic and/or urethral pain is strongly associated with trigonitis, as well as dysuria [1] [5].

• Recurrent Infection

  infections, may result in chronic inflammatory changes leading to metaplasia. [emedicine.com]

  Generally speaking, I have good bladder capacity so when the first urologist I saw in 2009 suggested IC rather than recurrent infections, I declined a cytoscopy/hydrodilation procedure (it was very expensive and I did not feel that it would add value [icbpsforum.com]

• Asymptomatic

  History Individuals with squamous metaplastic changes in the bladder may be asymptomatic or present with irritative voiding symptoms (eg, frequency, urgency, dysuria), recurrent urinary tract infections (UTIs), hematuria, or pelvic pain. [emedicine.medscape.com]

  […] seen with the long term insertion of an indwelling urinary catheter which may be used for : Urinary incontinence Urinary retention Post-operatively after surgery to the bladder, prostate or genitals Trigonitis Symptoms A person with trigonitis may be asymptomatic [healthhype.com]

• Suggestibility

  Trigonitis, despite its name suggestive of inflammation, is a metaplastic process. [emedicine.com]

  The possible role of oestrogen stimulation is discussed, together with a suggestion that the trigone has an embryological derivation distinct from the remainder of the bladder, allowing the trigonal epithelium to respond to oestrogenic stimulation in [ncbi.nlm.nih.gov]

• Learning Difficulties

  Patients are characterized by a tall eunuchoid stature, small testes, hypergonotrophic hypogonadism, gynecomastia, learning difficulties and infertility. These patients have also been found to have raised estrogen levels. [ncbi.nlm.nih.gov]

• Urinary Incontinence

  Some common ones are Cystitis - inflammation of the bladder, often from an infection Urinary incontinence - loss of bladder control Overactive bladder - a condition in which the bladder squeezes urine out at the wrong time Interstitial cystitis - a chronic [icdlist.com]

  SYMPTOMS: Trigonitis and chronic cystitis can cause severe bladder pain and burning, pelvic pain and pressure, reduced bladder capacity, an increase in the frequency and urge to urinate, particularly at night, blood in the urine and urinary incontinence [dawnscarzellamd.com]

  Persistent irritation of the trigone in this manner may be seen with the long term insertion of an indwelling urinary catheter which may be used for : Urinary incontinence Urinary retention Post-operatively after surgery to the bladder, prostate or genitals [healthhype.com]

  When patients have had surgery and their urinary sphincter has gotten damaged we call this instrinsic sphincter dysfunction (or Type III urinary incontinence). [cheyenneurological.com]

• Urinary Urgency

  It can cause urinary urgency and pelvic pain. Diagnosis is typically made during a scope examination of the bladder. Treatment may include antibiotics or surgical laser treatment. [patientslikeme.com]

  Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help?. J Urol. 2004 Jul. 172(1):232-5. [Medline]. Costantini E, Zucchi A, Del Zingaro M, Mearini L. [emedicine.medscape.com]

• Dysuria

  Moreover, studies have identified that the presence of pelvic and/or urethral pain is strongly associated with trigonitis, as well as dysuria. Given the nonspecific clinical presentation of lower urinary tract symptoms, the diagnosis is difficult. [symptoma.com]

  History Individuals with squamous metaplastic changes in the bladder may be asymptomatic or present with irritative voiding symptoms (eg, frequency, urgency, dysuria), recurrent urinary tract infections (UTIs), hematuria, or pelvic pain. [emedicine.medscape.com]

  Dysuria- Discomfort or pain while urinating. Pain in the pelvic area. Pain in certain sitting positions or discomfort during sex. Some of these symptoms may trigger in case people are sensitive to certain foods. [epainassist.com]

  Dysuria which is pain or discomfort when urinating Hematuria which is blood in the urine Pain or discomfort in your pelvic area. [healthool.com]

  Symptoms of trigonitis may include : Frequent urination (frequency) Discomfort or pain during urination (dysuria) Urgency to urinate Blood in the urine (hematuria) Pelvic discomfort or pain Recurrent UTIs may be another feature of trigonitis. [healthhype.com]

• Frequency of Micturition

  These epithelial changes can produce symptoms such as increased frequency of micturition and urgency. Cystoscopy with biopsy and subsequent histopathological examination is necessary to make the diagnosis. [symptoma.com]

Given the nonspecific clinical presentation of lower urinary tract symptoms, the diagnosis is difficult. Firstly, it is necessary to rule out more common causes of such complaints, such as infections, which is why a thorough patient history that will assess the course and progression of symptoms, and a detailed physical examination that focuses on abdominal palpation and observation of vital signs and other systems, are necessary steps in the workup. Pharmacologic administration of estrogen was reported in males to be a precipitating event, thus male patients could be asked about recent medication [2]. Urinalysis in the setting of trigonitis reveals a sterile urine culture and normal findings [2]. As the diagnosis is not yet confirmed, more advanced urological procedures should be employed. Ultrasonography (US) is of limited use (although it may show thickening of the bladder neck) [6], while cystoscopy is the gold standard for diagnosis. A grayish mucosa with a hyperemic margin in the trigone area is considered highly specific for trigonitis [2]. In presence of clinical suspicion, a biopsy sample for histological examination is recommended. The diagnosis is confirmed when the non-keratinizing squamous epithelium is seen instead of the standard transitional epithelium of the bladder on light microscopy [1] [2].

• Pyuria

  […] of trigonitis with chronic cervicitis and vaginitis; diagnosis and treatment. ( 20290774 ) 1947 13 Epithelium of vaginal type in the female trigone; the clinical problem of trigonitis. ( 20243913 ) 1947 14 Urethro-trigonitis in relation to abacterial pyuria [malacards.org]

  Anyway, he has agreed to finishing a 10 day course of Bactrim (in response to the growth of Enterobacter Aerogenes, admittedly without pyuria, last week) and then doing two months of daily Macrodantin, and has also given me a script for Endep 25 for neuromodulation [icbpsforum.com]

• Squamous Metaplasia of the Bladder

  Although the precise underlying cause is not known, squamous metaplasia in the bladder usually occurs in response to an irritative (eg, chronic indwelling catheter) or infectious process. [emedicine.com]

  Non-keratinizing squamous metaplasia of the bladder neck and trigone can be seen in 50-70% of premenopausal women and is considered a normal variant. [sharecare.com]

1. Stavropoulos M, Papatsoris AG, Konstantinidis C, Chrisofos M. Pseudomembranous Trigonitis: A Common but Underrecognized Urological Entity. Adv Urol. 2010;2010:269254.
2. Lian DW, Li FX, Ong CC, Kuick C, Chang KT. Pseudomembranous trigonitis in a male with Klinefelter syndrome: a case report and evidence of a hormonal etiology. Int J Clin Exp Pathol. 2014;7(6):3375-3379.
3. Stephenson TJ, Henry L, Harris SC, Giri DD, Fox M, Underwood JC. Pseudomembranous trigonitis of the bladder: hormonal aetiology. J Clin Pathol. 1989;42(9):922-926.
4. Henry L, Fox M. Histological findings in pseudomembranous trigonitis. J Clin Pathol. 1971;24:605–608.
5. Burkhard FC, Blick N, Hochreiter WW, Studer UE. Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help? J Urol. 2004;172(1):232-235.
6. Sugaya K, Nishijima S, Oda M, et al. Transabdominal vesical sonography of urethral syndrome and stress incontinence. Int J Urol. 2003;10(1):36-42.