Diverticular colovesical fistula: What should we really be doing?

N. L. Bertelson, H. Abcarian, K. A. Kalkbrenner, J. Blumetti, J. L. Harrison, V. Chaudhry, T. M. Young-Fadok

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Colovesical fistula secondary to diverticular disease is increasing in incidence. Presentation and severity may differ, but a common management strategy may be applied. The aim of this study is to evaluate the characteristics and perioperative management of patients with colovesical fistulae and determine optimal management. Methods: From 2003 to 2012, all charts of surgical patients with diverticular colovesical fistulae at two different institutions were reviewed. Patient and presentation characteristics and perioperative management and outcomes were recorded. Patient groups with early and late catheter removal (< 8 and ≥ 8 days) were compared with significance level set at p < 0.05. Results: Seventy-eight patient charts were reviewed. The mean duration of symptoms was 7.5 months. Laparoscopic assisted surgery was carried out in 35% of patients. Complex bladder repair was performed in 27%. Mean length of stay was 8 days. Mean urinary catheter duration was 13 days. Seventy percent of patients underwent postoperative cystogram, with 4% positive for extravasation. Patients with early catheter removal were significantly older, more likely to have received intraoperative methylene blue instillation, and less likely to have had a complex bladder repair (p < 0.05). Complication rate, length of stay, postoperative cystography, and stent use were similar for both catheter removal groups. Conclusions: Intraoperative methylene blue bladder instillation should be utilized to limit unnecessary bladder repairs. In the setting of negative methylene blue extravasation, surgeons may confidently remove urinary catheters in 7 days or less, in some cases as early as 48 h. In complex bladder repairs, cystogram is still an important adjunct, with those patients with negative studies benefiting from catheter removal at 7 days or less.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalTechniques in Coloproctology
DOIs
StateAccepted/In press - Dec 6 2017

Fingerprint

Intestinal Fistula
Methylene Blue
Urinary Bladder
Catheters
Urinary Catheters
Length of Stay
Intravesical Administration
Laparoscopy
Stents

Keywords

  • Colovesical fistula
  • Cystogram
  • Diverticular disease
  • Intestinal fistula
  • Methylene blue
  • Urinary bladder fistula
  • Urinary catheter

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Bertelson, N. L., Abcarian, H., Kalkbrenner, K. A., Blumetti, J., Harrison, J. L., Chaudhry, V., & Young-Fadok, T. M. (Accepted/In press). Diverticular colovesical fistula: What should we really be doing? Techniques in Coloproctology, 1-6. https://doi.org/10.1007/s10151-017-1733-6

Diverticular colovesical fistula : What should we really be doing? / Bertelson, N. L.; Abcarian, H.; Kalkbrenner, K. A.; Blumetti, J.; Harrison, J. L.; Chaudhry, V.; Young-Fadok, T. M.

In: Techniques in Coloproctology, 06.12.2017, p. 1-6.

Research output: Contribution to journalArticle

Bertelson, NL, Abcarian, H, Kalkbrenner, KA, Blumetti, J, Harrison, JL, Chaudhry, V & Young-Fadok, TM 2017, 'Diverticular colovesical fistula: What should we really be doing?', Techniques in Coloproctology, pp. 1-6. https://doi.org/10.1007/s10151-017-1733-6
Bertelson NL, Abcarian H, Kalkbrenner KA, Blumetti J, Harrison JL, Chaudhry V et al. Diverticular colovesical fistula: What should we really be doing? Techniques in Coloproctology. 2017 Dec 6;1-6. https://doi.org/10.1007/s10151-017-1733-6
Bertelson, N. L. ; Abcarian, H. ; Kalkbrenner, K. A. ; Blumetti, J. ; Harrison, J. L. ; Chaudhry, V. ; Young-Fadok, T. M. / Diverticular colovesical fistula : What should we really be doing?. In: Techniques in Coloproctology. 2017 ; pp. 1-6.
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abstract = "Background: Colovesical fistula secondary to diverticular disease is increasing in incidence. Presentation and severity may differ, but a common management strategy may be applied. The aim of this study is to evaluate the characteristics and perioperative management of patients with colovesical fistulae and determine optimal management. Methods: From 2003 to 2012, all charts of surgical patients with diverticular colovesical fistulae at two different institutions were reviewed. Patient and presentation characteristics and perioperative management and outcomes were recorded. Patient groups with early and late catheter removal (< 8 and ≥ 8 days) were compared with significance level set at p < 0.05. Results: Seventy-eight patient charts were reviewed. The mean duration of symptoms was 7.5 months. Laparoscopic assisted surgery was carried out in 35{\%} of patients. Complex bladder repair was performed in 27{\%}. Mean length of stay was 8 days. Mean urinary catheter duration was 13 days. Seventy percent of patients underwent postoperative cystogram, with 4{\%} positive for extravasation. Patients with early catheter removal were significantly older, more likely to have received intraoperative methylene blue instillation, and less likely to have had a complex bladder repair (p < 0.05). Complication rate, length of stay, postoperative cystography, and stent use were similar for both catheter removal groups. Conclusions: Intraoperative methylene blue bladder instillation should be utilized to limit unnecessary bladder repairs. In the setting of negative methylene blue extravasation, surgeons may confidently remove urinary catheters in 7 days or less, in some cases as early as 48 h. In complex bladder repairs, cystogram is still an important adjunct, with those patients with negative studies benefiting from catheter removal at 7 days or less.",
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AU - Harrison, J. L.

AU - Chaudhry, V.

AU - Young-Fadok, T. M.

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AB - Background: Colovesical fistula secondary to diverticular disease is increasing in incidence. Presentation and severity may differ, but a common management strategy may be applied. The aim of this study is to evaluate the characteristics and perioperative management of patients with colovesical fistulae and determine optimal management. Methods: From 2003 to 2012, all charts of surgical patients with diverticular colovesical fistulae at two different institutions were reviewed. Patient and presentation characteristics and perioperative management and outcomes were recorded. Patient groups with early and late catheter removal (< 8 and ≥ 8 days) were compared with significance level set at p < 0.05. Results: Seventy-eight patient charts were reviewed. The mean duration of symptoms was 7.5 months. Laparoscopic assisted surgery was carried out in 35% of patients. Complex bladder repair was performed in 27%. Mean length of stay was 8 days. Mean urinary catheter duration was 13 days. Seventy percent of patients underwent postoperative cystogram, with 4% positive for extravasation. Patients with early catheter removal were significantly older, more likely to have received intraoperative methylene blue instillation, and less likely to have had a complex bladder repair (p < 0.05). Complication rate, length of stay, postoperative cystography, and stent use were similar for both catheter removal groups. Conclusions: Intraoperative methylene blue bladder instillation should be utilized to limit unnecessary bladder repairs. In the setting of negative methylene blue extravasation, surgeons may confidently remove urinary catheters in 7 days or less, in some cases as early as 48 h. In complex bladder repairs, cystogram is still an important adjunct, with those patients with negative studies benefiting from catheter removal at 7 days or less.

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KW - Methylene blue

KW - Urinary bladder fistula

KW - Urinary catheter

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