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

Abstract

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.

Early Urinary Catheter Removal After Colectomy for Colovesical Fistula is Not Associated With Increased Postoperative Complications

“…We chose ≤7 days as the definition for early urinary catheter removal because that was the precedent in previous studies. 4-13 This study suggests that the definition of early and late should be reconsidered, perhaps with 3-5 days as the new definition for late.…”

“…We chose ≤7 days as the definition for early urinary catheter removal because that was the precedent in previous studies. [4][5][6][7][8][9][10][11][12][13] This study suggests that the definition of early and late should be reconsidered, perhaps with 3-5 days as the new definition for late. Some fistulous openings in the bladder may not be identifiable because of small size and associated inflammation while others are easily identified.…”