Diverticular colovesical fistula: What should we really be doing?

Bertelson, Noelle L.; Abcarian, Herand; Kalkbrenner, Kristen A; Blumetti, Jennifer; Harrison, Jacqueline; Chaudhry, Vivek; Young‐Fadok, Tonia M.

doi:10.1007/s10151-017-1733-6

Cited by 21 publications

(33 citation statements)

References 15 publications

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“…The median duration of catheterization in the present study was 10.5 (IQR: 7.3-14.0) days. This is longer than in previous studies, in which it was reported that it is safe to remove the catheter after 7-10 days in patients with uncomplicated enterovesical fistulas [3][4][5][6]. We observed no clinical recurrences in the early postoperative period in the patients who had a cystogram.…”

Section: Discussionmentioning

confidence: 47%

Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula

et al. 2019

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Aim Patients undergoing resectional surgery for enterovesical fistulas generally have an indwelling urinary catheter postoperatively to prevent a recurrent fistula. The aim of this study was to assess the role of a cystogram as part of the postoperative follow-up of such surgery, when it should be performed and for how long the bladder should be drained after surgery.Method A retrospective single-centre study of all patients undergoing ileocaecal or sigmoid resection for surgery for enterovesical fistula with the primary endpoint of recurrent urinary fistula. ResultsBetween 1994 and 2015, 46 patients (23 male; mean age 55.4 AE 18.3 years) underwent surgery [23 (50%) for diverticular disease, 16 (34.8%) for Crohn's disease, five (10.9%) for malignancy and two (4.3%) for previous radiotherapy]. Closure of the bladder fistula was by simple suture in 21 (46%) patients and with an omental pedicle in 16 (36%). Overall median duration of urinary drainage was 10.5 [interquartile range (IQR): 7.3-14.0] days. A postoperative cystogram was performed in 26 (57%) patients after a median of 10.0 (IQR: 8.0-13.0) days.This demonstrated persistent leakage in three patients, of whom two had undergone surgical closure of the bladder. This group required prolonged drainage (7, 19 and 40 days). One patient who had undergone surgery following radiotherapy for urothelial cancer developed a recurrent malignant fistula at 9 months, even though the postoperative cystogram had been negative.Conclusion This study suggests that a routine postoperative cystogram after surgery for enterovesical fistula may not be necessary for all patients if the bladder is drained for 1-2 weeks after bowel resection.

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Section: Discussionmentioning

confidence: 47%

Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula

et al. 2019

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“…However, the proper intra-operative management of the bladder defect and the duration of urethral catheter decompression are unclear. Other studies have questioned the need for formal bladder repair and specific intraoperative bladder management as potentially increasing operative time without significant clinical benefit in most cases [5,6,9]. Indeed, CVF was historically treated by resecting the entire fistula-including a partial cystectomy-with subsequent primary repair of the bladder defect.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, CVF was historically treated by resecting the entire fistula-including a partial cystectomy-with subsequent primary repair of the bladder defect. However, several studies support the practice that in benign disease bladder resection and repair is not necessary, and that the bladder can be managed simply with Foley catheter decompression without an increased risk for bladder-related complications or fistula recurrence [5,6,9,12,13].…”

Section: Discussionmentioning

confidence: 99%

“…There is no standard management of the bladder defect after fistula takedown. Large defects are universally repaired; however, small or grossly undetectable defects may not require closure [5,9]. The integrity of the bladder can be assessed intraoperative with provocative leak testing (for example, by instilling dyed saline into the bladder), and postoperatively with sigmoid colectomy for diverticulitis complicated by CVF.…”

Section: Objectivesmentioning

confidence: 99%

“…Postoperative bladder decompression with Foley catheter is routine, and is often continued for 14 days intending to allow the bladder defect to heal under minimal pressure. The desire to avoid bladder distention in the early postoperative period is balanced with the risks of catheter associated urinary tract infection, patient discomfort, decreased patient mobility, and prolonged hospital stay due prolonged catheter drainage of the bladder [9,10,11]. Some studies support early catheter removal (less than 7 days) implying that longer durations of bladder decompression impart unnecessary risk and little benefit [1,9].…”

Section: Objectivesmentioning

confidence: 99%

See 2 more Smart Citations

Early Removal of Foley Catheter after Sigmoid Colectomy for Diverticular Colovesical Fistula without Intraoperative Bladder Repair or Postoperative Cystography: Feasibility of a Quality Improvement Pilot Program

Anthony¹,

Kitamura²,

John³

et al. 2019

Int J Surg Res Pract

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Background: The treatment of colovesical fistula (CVF) due to diverticular disease is complex and imposes significant risk to the patient. Specifically, management of the bladder defect after fistula takedown is inconstant. In this quality improvement study, we report on the safety of early (< 7 days) urethral catheter removal without intraoperative or postoperative bladder imaging. Methods: Between 2008 and 2018, patients who were operated on for CVF due to diverticular disease were identified retrospectively. Medical records were reviewed to obtain patient characteristics, operative technique and findings, and postoperative outcomes. Results: Between 2008 and 2018, 17 patients with diverticulitis-induced CVF underwent fistula takedown. Bladder defects were only formally repaired if urothelium was visualized intraoperatively. Mean postoperative urethral catheterization was 5.5 days and bladder imaging was not performed intraoperatively or postoperatively. There were no urinary-related complications or mortalities, and mean follow-up was 249 ± 60 days. Conclusion: This quality improvement pilot study supports early catheter removal (< 7 days) and suggests bladder imaging may be unnecessary in select cases.

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Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center

Brière,

Simard,

Rouleau-Fournier

et al. 2024

Langenbecks Arch Surg

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Diverticular colovesical fistula: What should we really be doing?

Cited by 21 publications

References 15 publications

Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula

Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula

Early Removal of Foley Catheter after Sigmoid Colectomy for Diverticular Colovesical Fistula without Intraoperative Bladder Repair or Postoperative Cystography: Feasibility of a Quality Improvement Pilot Program

Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center

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