Appendico-vesical fistula and persistent urachus in a patient with hematuria

A 35-year-old man had been treated with sulfamethizole on 6 occasions because of recurrent urinary tract infections. Furthermore, he had experienced diffuse monosymptomatic hematuria for 15 years. Cystoscopy and biopsy demonstrated irregular intestinal mucosa. Physical examination and intravenous urography were normal. Preoperative diagnosis was urachus-derived adenoma with the possibility of adenocarcinoma. At operation a typical urachus and--surprisingly--an appendico-vesical fistula was found.