eMedicine Specialties > Urology > Fistulas

Enterovesical Fistula: Follow-up

Author: Joseph Basler, MD, PhD, Professor, Department of Urology, University of Texas Health Science Center at San Antonio; Chief, Section of Urology, Audie Murphy Veterans Affairs Hospital
Coauthor(s): Christopher H Cantrill, MD, Resident Physician, Department of Urology, University of Texas Health Science Center, San Antonio; Angela Kamerer Schang, MD, Attending Urologist, McKay Urology; Ann S Fenton, MD, MPH, Chief, Urology Flight Surgical Services/SGOSU, 1st Fighter Wing Hospital, Langley Air Force Base; Consulting Staff, Department of Urology, Naval Medical Center Portsmouth; Assistant Professor, Eastern Virginia Medical School
Contributor Information and Disclosures

Updated: Nov 18, 2009

Outcome and Prognosis

In a retrospective record review of 76 patients diagnosed with enterovesical fistula over a 12-year period, the complication rate in those treated with single-stage repair was not statistically different from that in patients who underwent multistage repair.65

In general, the overall outcome and prognosis are excellent in patients with non–radiation-induced or cancer-induced fistulae. Such patients usually respond well to resection of the diseased colon and have no significant urinary sequelae.

The prognosis in patients with colon carcinoma and fistulization is less favorable because the involvement of the bladder usually heralds a more aggressive tumor that often is metastatic at the time of detection.

Radiation-induced fistulae are more likely to recur, but the long-term patient prognosis may be better if the malignancy for which the radiation was administered has been controlled.

Future and Controversies

Future treatment of typical enterovesical fistulae may focus on development and refinement of minimally invasive surgical techniques, such as laparoscopic and robotic, to shorten recovery time and to potentially decrease hospital stay. The benefit and complications of preoperative ureteral stenting for intraoperative identification of the ureter may become a particular area of interest for clinical study. As of the latest review of this article, there is little clinical data to demonstrate the benefit of ureteral stents in preventing ureteral injury.

New modalities in neoadjuvant chemotherapy may allow further bladder preservation strategies. Trends in radiation oncology that permit minimization of collateral organ damage (eg, conformal external beam radiotherapy) and the use of tumor-specific radiosensitizing agents may be highly useful in preventing radiation-induced fistulae.

Improved surgical techniques, including laparoscopic procedures that greatly enhance visualization of the operative field, hold promise for fewer fistula-related complications of gynecologic and urologic procedures.

Advancements in molecular biology and the development of medications to manipulate inflammatory mediators may eventually produce more specifically targeted therapies to decrease the risk of fistula formation in inflammatory conditions, particularly Crohn disease.

Given the low incidence of colovesical fistula, the development of and recruitment for prospective randomized studies is difficult.

 


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References
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Further Reading

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Keywords

enterovesical fistula, enterovesical fistulae, colovesical fistula, colovesical fistulae, intestinovesical fistula, vesicocolic fistula, rectovesical fistula, ileovesical fistula, appendicovesical fistula, pneumaturia, fecaluria, urinary tract infections, UTIs, bowel disease, vesicoenteric fistula, rectourethral fistula, diverticular disease, Crohn disease, appendicitis, imperforate anus, diverticulitis, Crohn colitis, Meckel diverticulum, genitourinary coccidioidomycosis, pelvic actinomycosis, colorectal cancer, prostatectomy, laparoscopic inguinal hernia repair, Gouverneur syndrome, sigmoid diverticular disease

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Contributor Information and Disclosures

Author

Joseph Basler, MD, PhD, Professor, Department of Urology, University of Texas Health Science Center at San Antonio; Chief, Section of Urology, Audie Murphy Veterans Affairs Hospital
Joseph Basler, MD, PhD is a member of the following medical societies: American Urological Association, Society for Basic Urologic Research, Society of University Urologists, Society of Urologic Oncology, Southwest Oncology Group, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher H Cantrill, MD, Resident Physician, Department of Urology, University of Texas Health Science Center, San Antonio
Christopher H Cantrill, MD is a member of the following medical societies: American Association of Clinical Urologists, American Urological Association, and Endourological Society
Disclosure: Nothing to disclose.

Angela Kamerer Schang, MD, Attending Urologist, McKay Urology
Angela Kamerer Schang, MD is a member of the following medical societies: American Medical Association and American Urological Association
Disclosure: Nothing to disclose.

Ann S Fenton, MD, MPH, Chief, Urology Flight Surgical Services/SGOSU, 1st Fighter Wing Hospital, Langley Air Force Base; Consulting Staff, Department of Urology, Naval Medical Center Portsmouth; Assistant Professor, Eastern Virginia Medical School
Ann S Fenton, MD, MPH is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Erik T Goluboff, MD, Professor, Department of Urology, College of Physicians and Surgeons, Columbia University; Director of Urology, Allen Pavilion, New York Presbyterian Hospital
Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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