[The diagnosis and treatment of a postcystectomy enteroneovesical fistula].
Fistulae between the reservoir of the continent urinary bypass and the intestinal tract are uncommon and difficult to diagnose. To ascertain the clinic presentation, diagnosis and treatment of post-cystectomy enteroneovesical fistula due to a bladder tumour, 258 cases of radical cystectomies performed over a 6-year period were reviewed. Early and late fistulization were defined as those diagnosed before and after 3 months from surgery. Six male and one female patients, mean age 60.5 years, were included in the study. Fecaluria was the most common clinical presentation occurring in 85.7% cases. Three and two patients, respectively, were given neoadjuvant radiotherapy and adjuvant chemotherapy, fistula was early in 3 (42.8%) and late in 4 (57.2%) patients. Contrast examination of the neobladder (neocystogram) was the most effective diagnostic method. Conservative treatment with a low waste diet and continuous urinary drainage was used in 4 patients; this was fully effective in two patients with early fistula. Surgical treatment was effective in 100% cases. Fistula etiology appears to be develop from multiple reasons, radiotherapy being the major predisposing factor. A neocystogram should be performed in all patients with a suspicious enteroneovesical fistula. When no evidence of tumoral recurrence, poor nutritional status, or stoma obstruction in present and the fistula is early, treatment should be approached with a low-waste diet and continuous urinary catheterization. Surgery is indicated in cases with late fistulization and after failure of conservative therapy.
Ubirajara Barroso
J
J
Servicio de Urología, Wayne State University, Barbara Ann Karmanos Cancer Center Institute, Detroit, Michigan, USA.
da Silva
E A
EA
Alvim Barroso
V
V
Gómes de Oliveira
J
J
Edson Pontes
J
J
D000368:Aged; D012809:Colon, Sigmoid / Q000601:surgery; D003131:Combined Modality Therapy; D015653:Cystectomy; D005243:Feces; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy / Q000652:urine; D011859:Radiography; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000175:diagnosis* / Q000628:therapy / Q000652:urine; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000601:surgery; D014547:Urinary Diversion