Colovesicle fistula: presentation, management, and outcomes

Abstract Background Colovesical fistula (CVF) is a rare condition characterized by the passage of air and/or feces in the urine, but there is still no consensus on the evaluation and treatment of this condition. This study aimed to identify the presentation, causes, diagnostic modalities, management, and outcomes of CVF at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods This was a retrospective study of patients diagnosed with CVF at King Abdulaziz Medical City over six years. We identified 19 patients and collected their demographic features, presenting symptoms, underling etiology, as well as diagnostic tools, treatments, and outcomes. Results The study sample included 19 patients (14 males and 5 females) with a mean age of 46.37 ± 18.94 years. The most common cause of CVF was non-malignant conditions with diverticulitis in eight cases (42.1%). Fecaluria was the most common presenting symptom in 10 patients (52.6%) followed by urinary tract infection in six (31.6%), dysuria in six (31.6%), and hematuria in six (31.6%). Computed tomography (CT) was the most common diagnostic modality used in 16 cases (84.2%) followed by cystoscopy in 13 (68.4%). Open surgery was the primary management modality with laparoscopic surgery employed in five cases (26.3%). Surgical complications included ureteric injury and anastomotic leak—these were each seen in one case (5.3%). Two patients with non-malignant fistula recurred, and one patient died in the post-operative course. Conclusion Diverticulitis is the commonest cause of CVF. The treatment needs a multidisciplinary approach with most patients needing surgical repair while conservative treatment being reserved for selected cases.