Colovesical Fistula: A 28 year experience at a major United States Department of Veterans Affairs Medical Center

Objective: This study describes our 28-year experience with colovesical fistula at a major United States Department of Veterans Affairs Medical Center and highlights the clinical presentation and treatment strategies used to manage this condition. Methods: We reviewed patient charts from the electronic medical record of the Department of Veterans Affairs. All patients who underwent colectomies, bladder repairs and management of gastrointestinal fistulas were downloaded to identify those who had the diagnosis of CVF. The historical cohort identified 12 patients from 1992 to 2004, with an additional 29 patients managed from January 2005 to December 2020. Patient demographics, diagnostic approaches, and surgical treatment were collected and compared between the two groups. Results: In both cohorts, almost all patients were male and the average age among them was 65.9 years. The etiology of CVF was overwhelmingly due to diverticulitis, with bladder cancer, radiation treatment, and colon cancer responsible for the remainder. The findings between the two cohorts were very similar. Major symptoms included pneumaturia, fecaluria, and frequent bladder infections. Preoperative evaluation included CT, cystoscopy, cystography, intravenous pyelogram, barium enema, and colonoscopy. CT was most likely to confirm the diagnosis. Thirty-three of the 41 patients underwent surgical repair of their CVFs, most as a one-stage procedure, and many using laparoscopic techniques. Eight patients were managed with permanent ostomies because of serious co-morbid disorders. Conclusions: This 28-year experience indicates that diverticulitis is the leading cause of CVF followed by cancer of the bladder or colon, and radiation treatment. CT is the most reliable diagnostic imaging modality. A majority of patients can have their fistulas managed surgically, many with a one-stage procedure, and frequently performed laparoscopically with very good results.