- Matt Strickland, MD
Matt Strickland, MD
- Senior General Surgery Resident
- University of Toronto
- Marcus Burnstein, MD, MSc, FRCSC
Marcus Burnstein, MD, MSc, FRCSC
- Associate Professor of Surgery
- University of Toronto
- Zane Cohen, MD, FRCSC
Zane Cohen, MD, FRCSC
- Professor of Surgery
- University of Toronto
A colovesical fistula (CVF) is an abnormal connection between the colon and urinary bladder. Although they are uncommon, CVFs can cause significant morbidity, affect quality of life, and may lead to death, usually secondary to urosepsis [1,2]. Although a CVF can be diagnosed clinically, imaging and endoscopy are often required to delineate the extent of a fistula and to elucidate its etiology . Surgery is usually required to repair a CVF.
The epidemiology, etiology, clinical features, diagnosis, and management of colovesical fistulas are reviewed here. Other types of fistulas related to the gastrointestinal and urological systems are covered in separate topic reviews. (See "Overview of enteric fistulas" and "Rectovaginal and anovaginal fistulas" and "Anorectal fistula: Clinical manifestations, diagnosis, and management principles" and "Urogenital tract fistulas in women".)
The precise incidence of colovesical fistulas (CVFs) is unknown. It is estimated that CVFs account for 1 in every 3000 surgical hospital admissions . In patients with diverticular disease, 2 to 18 percent were found to have CVFs [5-8]. In patients with Crohn’s disease, less than 1 percent developed a CVF .
The male-to-female ratio of CVF is approximately 2 to 3:1 [1,10-13]. Females are protected possibly because the uterus and broad ligaments act as a barrier between the sigmoid colon and the bladder. This theory is supported by the fact that a high percentage of females with CVFs (>50 percent in some series) have had a previous hysterectomy .
CVFs most commonly affect patients in their sixth or seventh decades. The mean age at presentation is between 55 and 75 years [1,10-12].
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- CLINICAL MANIFESTATIONS
- EVALUATION AND DIAGNOSIS
- Initial tests to diagnose colovesical fistula
- - Urinalysis and urine culture
- - Abdominopelvic CT with oral or rectal contrast
- Lower gastrointestinal endoscopy to identify etiology
- Cystoscopy for suspected malignant fistula
- Infrequently performed tests
- Treat symptomatic infection if present
- Definitive treatment of fistula
- - Operative management
- Benign fistula
- - Multistage operation
- - Laparoscopic operation
- Malignant fistula
- - Postoperative management of the bladder
- Nonoperative management
- SUMMARY AND RECOMMENDATIONS