[The diagnosis and treatment of a postcystectomy enteroneovesical fistula]

Fistulae between the reservoir of the continent urinary bypass and the intestinal tract are uncommon and difficult to diagnose. To ascertain the clinic presentation, diagnosis and treatment of post-cystectomy enteroneovesical fistula due to a bladder tumour, 258 cases of radical cystectomies performed over a 6-year period were reviewed. Early and late fistulization were defined as those diagnosed before and after 3 months from surgery. Six male and one female patients, mean age 60.5 years, were included in the study. Fecaluria was the most common clinical presentation occurring in 85.7% cases. Three and two patients, respectively, were given neoadjuvant radiotherapy and adjuvant chemotherapy, fistula was early in 3 (42.8%) and late in 4 (57.2%) patients. Contrast examination of the neobladder (neocystogram) was the most effective diagnostic method. Conservative treatment with a low waste diet and continuous urinary drainage was used in 4 patients; this was fully effective in two patients with early fistula. Surgical treatment was effective in 100% cases. Fistula etiology appears to be develop from multiple reasons, radiotherapy being the major predisposing factor. A neocystogram should be performed in all patients with a suspicious enteroneovesical fistula. When no evidence of tumoral recurrence, poor nutritional status, or stoma obstruction in present and the fistula is early, treatment should be approached with a low-waste diet and continuous urinary catheterization. Surgery is indicated in cases with late fistulization and after failure of conservative therapy.