Diagnosis and treatment of enterovesical fistulae.
OBJECTIVE
Enterovesical fistulae are a recognized complication of a variety of inflammatory and neoplastic conditions. Despite advances in imaging and treatment the diagnosis may be delayed and the management remains diverse. We describe our experience with their diagnosis and management.


METHODS
This retrospective study encompassed all patients referred over a 10-year period with clinical suspicion of or confirmed enterovesical fistula. Demographics, clinical presentation, aetiology and clinical outcome were evaluated. Mean follow-up was 18 months (range 6-50 months).


RESULTS
Thirty patients were studied. The mean age was 63.5 years (range 23-92 years). Fifteen (50%) patients presented with classical urinary symptoms (pneumaturia, faecaluria and recurrent urinary tract infections). The commonest investigations (n, % positive) included CT (15, 80), cystoscopy (16, 87.5), endoscopy (11, 54.5) and barium enema (8, 50). There were 20 inflammatory and 10 neoplastic aetiologies. Five patients were treated conservatively and 25 patients underwent surgery. Surgery resulted in symptomatic cure in the majority of cases (22/25).


CONCLUSIONS
Classical urinary symptoms were only evident in 50% of patients with confirmed fistulae. We advocate CT scanning as the optimum imaging modality before surgical intervention. Surgical treatment in a specialized unit remains the most effective treatment of enterovesical fistulae.
Kavanagh
D
D
Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland. dara_kav@hotmail.com
Neary
P
P
Dodd
J D
JD
Sheahan
K M
KM
O'Donoghue
D
D
Hyland
J M P
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D003131:Combined Modality Therapy / Q000379:methods; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000175:diagnosis* / Q000628:therapy*