Management of enterovesical fistulas

Area of Science:

• Urology
• Gastroenterology
• Surgical Oncology

Background:

• Enterovesical fistulas are abnormal connections between the bladder and bowel.
• Common etiologies include diverticulitis, Crohn's disease, and colorectal cancer.

Purpose of the Study:

• To review the diagnosis, management, and outcomes of patients with enterovesical fistulas.
• To evaluate the effectiveness of different treatment modalities.

Main Methods:

• Retrospective review of 51 patients diagnosed with enterovesical fistulas between 1974 and 1988.
• Analysis of clinical history, urine culture, radiologic, endoscopic, operative, and autopsy findings.

Main Results:

• Diagnosis was primarily clinical (history and urine culture).
• Radiologic and endoscopic studies missed 20% of fistulas.
• One-stage bowel resection was successful in 66% of patients without complications.
• Antibiotic treatment without surgery was effective and preferable to colostomy for some patients.

Conclusions:

• Enterovesical fistula is a clinical diagnosis; preoperative studies should focus on underlying disease and malignancy.
• One-stage resection is the preferred surgical approach when feasible.
• Antibiotic management is superior to colostomy for patients not suitable for resection.