A 12-year experience with enterovesical fistulas.

OBJECTIVES: To review our experience with enterovesical fistulas in order to determine the most accurate diagnostic studies and most effective method of treatment.

METHODS: A retrospective record review of 76 patients who were diagnosed and treated for enterovesical fistulas over a 12-year period was performed. Data collection focused on presenting symptoms, urinary disease process, diagnostic studies, and methods of management.

RESULTS: Diverticular disease was the primary etiologic factor in the majority of patients (59%), with colonic malignancy, granulomatous bowel disease, and radiation therapy accounting for the majority of the remainder. Cystoscopy (60%) and cystography (44%) were the most sensitive diagnostic studies. There was no statistical difference in the complication rate between groups treated with single or multistage repair.

CONCLUSIONS: One-stage repair of enterovesical fistulas can be safely performed when the cause is diverticular or granulomatous bowel disease. Staged repairs may be more judicious in patients with large intervening pelvic abscesses or those in whom advanced malignancy or radiation changes are present.