The treatment of trigonitis is essentially medical and long-term. Few reports addressed the use of fulguration of the trigone.  A rural-based urologist has treated this case, the subject matter of this video, with cystoscopic cutterization of the trigone that ended up with a fistula. 6 months later, he treated her with attempted closure of the fistula that obviously failed. Afterwards, he inserted a customized polypropylene tape in her through the transobturator route.
The lady came to our attention with total urinary incontinence, with 2 basal vesico-vaginal fistulas and a large defect involving the bladder base and proximal urethra. She was using 5 adult-sized pads per day

After having examined the lady, a cystogram shows a small de-functionalized bladder with extensive leakage from the vagina. Under spinal anaesthesia, I started with cystoscopy, where both fistulae were identified as low lateral, right and left. A defect was noted in the proximal urethra and bladder neck, probably resulting from extensive ischemia of the tissues used for the previous attempt at closing the fistulas.
 Both fistulas were closed first: one by one. Then I started sharp dissection of the blader mucosa off the puckered vaginal mucosa.
Then, the proximal urethra and bladder neck were closed in 2 layers. A piece of anterior rectus sheath was used as a free interpositional graft between the bladder and vaginal. Lastly, the vaginal wall was closed, and a urethral catheter was left for 3 weeks

After 3 months, another cystogram was performed and showed reasonable bladder capacity with no evidence of fistulas.
The patient still has some stress and urge incontinence.
She was instructed to perform regular pelvic floor muscle training under the supervision of a urodynamic nurse and prescribed Solifenacine 10 mg with improvement. At 6 months, she will be re-evaluated for the possibility of surgical treatment of her stress incontinence.

The notion of cauterizing bladder trigonitis is quite risky, and the transobturator tape in inexperienced hands could be dangerous