Colovesical and Other Enterovesical Fistulas

Excerpt

Enterovesical fistulas are pathological connections between the gastrointestinal tract and the urinary bladder, resulting in considerable morbidity due to recurrent urosepsis in addition to the underlying disease. Colovesical fistulas represent the most common type, while other variants, eg, ileovesical, jejunovesical, and rectovesical fistulas, may occur independently or alongside concurrent enteroenteric, rectovaginal, or colouterine fistulas. The sigmoid colon is most commonly affected because of its anatomical proximity to the bladder dome, although any segment of the bowel may be involved.

Clinical manifestations include pneumaturia, fecaluria, and recurrent urinary tract infections; severe cases may progress to urosepsis and acute renal failure. Disease severity is influenced by the underlying etiology and patient-specific factors, eg, malignancy, immunosuppression, and nutritional status. Diagnostic evaluation aims to identify the cause to inform treatment decisions systematically. Although conservative management may be appropriate for select patients with benign etiologies, the majority require surgical intervention. Achieving optimal outcomes necessitates coordinated interprofessional collaboration among colorectal surgeons, urologists, gastroenterologists, nutritionists, and stoma therapists.