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Diagnosis and Surgical Management of Colovesical Fistulas Due to Sigmoid Diverticulitis

2009; Lippincott Williams & Wilkins; Volume: 182; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2009.05.022

1527-3792

Sebastian Melchior, Dragan Cudovic, Jon Jones, Christian Thomas, Rolf Gillitzer, Joachim W. Thüroff,

Appendicitis Diagnosis and Management

No AccessJournal of UrologyAdult Urology1 Sep 2009Diagnosis and Surgical Management of Colovesical Fistulas Due to Sigmoid Diverticulitis Sebastian Melchior, Dragan Cudovic, Jon Jones, Christian Thomas, Rolf Gillitzer, and Joachim Thüroff Sebastian MelchiorSebastian Melchior Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Department of Urology/Transplantation Centre, Klinikum Bremen-Mitte, Bremen, Germany Nothing to disclose. More articles by this author , Dragan CudovicDragan Cudovic Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author , Jon JonesJon Jones Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author , Christian ThomasChristian Thomas Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author , Rolf GillitzerRolf Gillitzer Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author , and Joachim ThüroffJoachim Thüroff Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Financial interest and/or other relationship with Pfizer. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.05.022AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Diverticular disease of the colon is the most frequent cause of colovesical fistulas. In this study we evaluated the accuracy of different diagnostic procedures for the detection of colovesical fistula and the clinical outcome in a series of 49 patients who underwent surgery for colovesical fistula due to sigmoid diverticulitis. Materials and Methods: Between 1982 and 2007, 42 men and 7 women underwent surgery for colovesical fistula due to sigmoid diverticulitis. Preoperative diagnostic procedures included the poppy seed test, abdominopelvic computerized tomography, magnetic resonance tomography of the abdomen, cystogram, retrograde colonic enema, urethrocystoscopy and colonoscopy. Results: All patients had urinary tract infections and dysuria. Pneumaturia and fecaluria, which are pathognomonic symptoms of colovesical fistula, were present in 71.4% and 51.0% of the patients (35 and 25 of 49), respectively. Colovesical fistula was correctly diagnosed by the poppy seed test in 94.6% (35 of 37 examined patients) compared to abdominopelvic computerized tomography in 61.0% (25 of 41), magnetic resonance tomography in 60.0% (3 of 5), cystogram in 16.7% (5 of 30), retrograde colonic enema in 35.7% (15 of 42), cystoscopy in 10.2% (5 of 49) and colonoscopy in 8.5% (4 of 47). Patients underwent resection of the fistulized bowel, single stage bowel anastomosis without protective colostomy and closure of the bladder defect. Postoperative morbidity was 8.2% (4 of 49) and mortality was 0%. During a median followup of 68 months there were no recurrent fistulas. Conclusions: In our series the poppy seed test had the highest sensitivity to detect colovesical fistulas. However, abdominopelvic computerized tomography, colonoscopy and cystoscopy are essential diagnostic procedures because the presence of colon or bladder cancer as an underlying cause of colovesical fistula will determine further therapy. References 1 : Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis2006; 8: 347. Google Scholar 2 : The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg2004; 188: 617. Google Scholar 3 : Fistula and conditions associated with diverticular disease of the colon. Clin Gastroenterol1975; 4: 171. 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Google Scholar © 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited bySmith Z, Johnson S, Golan S, McGinnis J, Steinberg G and Smith N (2017) Fistulous Complications following Radical Cystectomy for Bladder Cancer: Analysis of a Large Modern CohortJournal of Urology, VOL. 199, NO. 3, (663-668), Online publication date: 1-Mar-2018. Volume 182Issue 3September 2009Page: 978-982 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsintestinal fistulacolonicdiverticulitisseedsMetrics Author Information Sebastian Melchior Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Department of Urology/Transplantation Centre, Klinikum Bremen-Mitte, Bremen, Germany Nothing to disclose. More articles by this author Dragan Cudovic Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author Jon Jones Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author Christian Thomas Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author Rolf Gillitzer Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Nothing to disclose. More articles by this author Joachim Thüroff Department of Urology, Johannes Gutenberg University Medical School, Mainz, Germany Financial interest and/or other relationship with Pfizer. More articles by this author Expand All Advertisement PDF downloadLoading ...