title: The spectrum of colovesical fistula and diagnostic paradigm.
abstract: BACKGROUND
  Our experience with colovesical fistula (CVF) over a 12-year period was reviewed to clarify its clinical presentation and diagnostic confirmation.
  
  
  METHODS
  Twelve patients with CVF were identified. Presenting symptoms, etiologic factors, diagnostic investigations, and subsequent treatment were reviewed.
  
  
  RESULTS
  Underlying etiologies were diverticular disease (75%), colon cancer (16%), and bladder cancer (8%). Pneumaturia (77%) was the most common presentation, followed by urinary tract infections, dysuria and frequency (45%), fecaluria (36%), hematuria (22%), and orchitis (10%). The ability of various preoperative investigations to identify a CVF were: computed tomography (CT) (90%), barium enema (BE) (20%), and cystography (11%), whereas cystoscopy, intravenous pyelogram (IVP), and colonoscopy were nondiagnostic. All patients underwent single- or multiple-staged repair of the fistula.
  
  
  CONCLUSIONS
  In patients with a suspected CVF, we recommend CT followed by a colonoscopy as a first-line investigation to rule out malignancy as a cause of CVF. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management.
authors.affiliation: Department of Surgery, Hunter Holmes McGuire Veterans Affairs Medical Center and Virginia Commonwealth University Medical Center, 1201 Broad Rock Blvd, Richmond, VA 23249, USA.
authors.forename: Samer F
authors.initials: SF
authors.lastname: Najjar
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Jamal
authors.forename: Jeannie F
authors.initials: JF
authors.lastname: Savas
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D003113:Colonoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery