Diverticular colovesical fistula: What should we really be doing?

Area of Science:

• Gastroenterology
• Urology
• Surgical Oncology

Background:

• Colovesical fistula, a complication of diverticular disease, is increasing.
• Management strategies for colovesical fistulae can be standardized.
• This study evaluates patient characteristics and perioperative management for optimal outcomes.

Purpose of the Study:

• To assess the characteristics of patients with colovesical fistulae.
• To evaluate perioperative management strategies.
• To determine optimal management for colovesical fistulae.

Main Methods:

• Retrospective review of 78 surgical patients with diverticular colovesical fistulae (2003-2012).
• Comparison of early (<8 days) versus late (≥8 days) urinary catheter removal groups.
• Analysis of patient demographics, presentation, perioperative management, and outcomes.

Main Results:

• Mean symptom duration was 7.5 months; 35% underwent laparoscopic surgery.
• Mean hospital stay was 8 days, with a mean urinary catheter duration of 13 days.
• Early catheter removal was associated with older patients and less complex bladder repair; complication rates were similar.

Conclusions:

• Intraoperative methylene blue instillation aids in avoiding unnecessary bladder repairs.
• Urinary catheters can be safely removed within 7 days (or earlier) if methylene blue extravasation is negative.
• Postoperative cystogram remains important for complex repairs, guiding catheter removal within 7 days for negative studies.