Colovesical fistula repair: is early Foley catheter removal safe?
BACKGROUND
Colovesical fistula (CVF) are the most common occurring fistulae secondary to diverticulitis. Review of the literature reveals great variability in postoperative Foley catheter management, as well as the role of a cystogram. The purpose of this study was to review our experience in early vs. late removal of the Foley catheter after CVF repair secondary to diverticulitis. Our hypothesis was that early Foley catheter removal is not associated with increased complications, and postoperative cystogram is of low value.


METHODS
This is a retrospective study (January 2002-March 2008) of all patients with a diagnosis of CVF secondary to diverticulitis, who were treated with a sigmoidectomy and takedown of the fistula. Hospital records were reviewed and demographics, days to Foley removal, performance of cystogram, type of repair, complications, and comorbidities were recorded. Patients were separated into two groups according to early or late Foley catheter removal. Removal of the Foley catheter in < or = 7 d was considered early, and removal in >7 d was considered late.


RESULTS
Thirty-two patients were identified, with a mean age of 65.2 y (42-91). Mean duration of Foley catheter stay was 15.6 d (3-42). Six patients had early postoperative Foley catheter removal and 26 patients had late Foley catheter removal. Four patients had complex bladder repair, and they all had late Foley catheter removal. From the 28 patients with simple bladder repair, six had early removal and 22 had late removal. Patients with early Foley catheter removal did not have significant complications compared with patients with late Foley catheter removal. Eleven patients got a cystogram postoperatively to detect possible bladder leaks. All cystograms performed were negative.


CONCLUSIONS
Patients with a diagnosis of CVF secondary to diverticulitis may have their Foley catheter removed in 7 d without any increased complications. The role of the cystogram is unclear; however, no value was added in simple bladder repairs.
de Moya
Marc A
MA
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. mdemoya@partners.org
Zacharias
Nikolaos
N
Osbourne
Audley
A
Butt
Muhammad Umar
MU
Alam
Hasan B
HB
King
David R
DR
McGovern
Francis
F
Velmahos
George C
GC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D012809:Colon, Sigmoid; D020878:Device Removal; D004239:Diverticulitis, Colonic / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014546:Urinary Catheterization; D014567:Urography