title: The poppy seed test for colovesical fistula: big bang, little bucks!
abstract: OBJECTIVE
  Diagnosis of a colovesical fistula is often challenging, and usually involves numerous invasive and expensive tests and procedures. The poppy seed test stands out as an exception to this rule. We evaluated the accuracy and cost-effectiveness of various established diagnostic tests used to evaluate a suspected colovesical fistula.
  
  
  METHODS
  We identified 20 prospectively entered patients with surgically confirmed colovesical fistulas between 2000 and 2006. Each patient was evaluated preoperatively with a (51)chromium nuclear study, computerized tomography of the abdomen and pelvis with oral and intravenous contrast medium, and the poppy seed test. Costs were calculated using institutional charges, 2006 Medicare limiting approved charges and the market price, respectively. The z test was used to compare the proportion of patients who tested positive for a fistula with each of these modalities.
  
  
  RESULTS
  The chromium study was positive in 16 of 20 patients (80%) at a cost of $490.83 per study. Computerized tomography was positive in 14 of 20 patients (70%) at a cost of $652.92 per study. The poppy seed test was positive in 20 of 20 patients (100%) at a cost of $5.37 per study. The difference in the proportion of patients who tested positive for a fistula on computerized tomography and the poppy seed test was statistically significant (p = 0.03). There was no difference between the chromium group and the computerized tomography or poppy seed group (p = 0.72 and 0.12, respectively).
  
  
  CONCLUSIONS
  The poppy seed test is an accurate, convenient and inexpensive diagnostic test. It is an ideal initial consideration for evaluating a suspected colovesical fistula.
authors.affiliation: Division of Urology, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Kwon
authors.forename: Noel A
authors.initials: NA
authors.lastname: Armenakas
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Scharf
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.forename: John A
authors.initials: JA
authors.lastname: Fracchia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003950:Diagnostic Techniques, Urological / Q000191:economics; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012639:Seeds