Management of the Bladder During Surgical Treatment of Enterovesical Fistulas from Benign Bowel Disease
Received 17 March 2008; accepted 6 May 2008. published online 14 July 2008.
Background
Management of the bladder in enterovesical fistulas from benign bowel disease is not well described in the literature and there is no clear consensus.
Study Design
A retrospective chart review was done of all patients with benign bowel disease and an enterovesical fistula who underwent definitive surgical management between January 1993 and December 2005. Patients were excluded if they had any history of abdominal cancer or pelvic radiation. Surgical management protocol for enterovesical fistulas included a period of perioperative bowel rest, surgical exploration, separation of the fistulized bowel from the bladder, resection of the diseased bowel segment, and Foley catheter placement for 1 week.
Results
Seventy-four patients were eligible for the study. The average patient age was 54.3 years (range 19 to 88 years old). Twenty-six women and 48 men underwent celiotomy and segmental resection of the offending bowel and bowel side of the fistula. The bladder side of the fistula was managed by Foley catheter alone in 68% and by surgical repair in 32%. Fifty-two patients had diverticulitis (70.3%) and 22 had Crohn's disease (29.7%). Mean followup was 26.4 months, and median followup was 6.45 months. One patient developed a colocutaneous and vesicocutaneous fistula after celiotomy. The remaining bladder defects healed within 1 week.
Conclusions
Successful surgical management of most enterovesical fistulas from diverticulitis or Crohn's disease requires only resection of the diseased bowel, with minimal need for repair or resection of the bladder side of the fistula. Indwelling Foley catheter placement alone is typically sufficient for bladder healing. Only when there are overt defects into the bladder should formal repair be undertaken.
Divisions of Urologic Surgery and Colorectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
Correspondence address: Eugene W Lee, c/o Steven B Brandes, MD, Division of Urologic Surgery, Washington University School of Medicine, 4860 Children's Pl, Campus Box 8242, St Louis, MO 63110
Disclosure Information: The following disclosure has been reported by the authors: Dr Brandes is a speaker for and has received honoraria from Pfizer and AMS.
ABSTRACT