title: [Colovesical fistulas : An interdisciplinary challenge].
abstract: BACKGROUND
  The aim of treatment of patients with colovesical fistulas should be prompt elimination of the infection and the social burden. We focused on the question whether a minimally invasive surgical approach as a cooperation between surgeons and urologists is possible. This requires effective diagnostics prior to the operation.
  
  
  METHODS
  Since 2007 a total of 32 patients with the clinical suspicion of colovesical fistula have undergone extensive preoperative diagnostics. Operative treatment aimed primarily for a minimally invasive approach. In particular, the validity of preoperative diagnostics was analyzed and surgical results were characterized by clinical success, complications and long-term effects.
  
  
  RESULTS
  The medical history significant for colovesical fistula and detected urinary infection provided the best evidence for the specific diagnosis. Cystoscopy, computed tomography (CT) scan and colonoscopy were only partially effective for predicting a fistula as subsequently diagnosed by histopathological investigations. Fistulas due to diverticulitis of the sigmoid colon occurred in 28 cases, while in 3 subjects there was a gynecological and inflammatory cause (malignant tumor growth, n = 1). A laparoscopic approach achieving repair and healing of the fistula was possible in 29 cases including conversion in 3 subjects because of intraoperative complications. The remaining patients underwent conventional treatment. The disease-related complication rate as revealed during follow-up was 10%.
  
  
  CONCLUSIONS
  Laparoscopic repair and healing of a colovesical fistula is possible in the majority of cases by the recommended preoperative ureteral stenting. As part of diagnostic measures, the medical history significant for a fistula and detection of urinary infections are the most reliable aspects. In the case of this combination together with a further diagnostic measure, a laparoscopic approach is always recommended. The recurrency rate is 0%.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Minimal-invasive Chirurgie, HELIOS Klinikum Aue, Gartenstraße 6, 08280, Aue, Deutschland. roland.albrecht@helios-kliniken.de.
authors.forename: R
authors.initials: R
authors.lastname: Albrecht
authors.affiliation: Klinik für Urologie und Kinderurologie, HELIOS Klinikum Aue, Aue, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Weirich
authors.affiliation: Klinik für Urologie und Kinderurologie, HELIOS Klinikum Aue, Aue, Deutschland.
authors.forename: O
authors.initials: O
authors.lastname: Reichelt
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Friedrich-Schiller-Universität Jena, Jena, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Settmacher
authors.affiliation: Klinik für Allgemein-, Viszeral- und Minimal-invasive Chirurgie, HELIOS Klinikum Aue, Gartenstraße 6, 08280, Aue, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Bochmann
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003113:Colonoscopy; D061887:Conversion to Open Surgery / Q000379:methods; D003558:Cystoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D001747:Urinary Bladder Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
keywords: Bladder; Diagnostics; Diverticulitis; Sigmoid colon; Therapy evaluation