Management of Colovesical fistula
Date First Published:
November 12, 2009
Last Updated:
November 26, 2009
Report by:
Dr Ishvar Naranji, FY2 (Ipswich Hospital NHS Trust)
Search checked by:
Mr Abdel Omar, Ipswich Hospital NHS Trust
Three-Part Question:
In [colovesical fistula] is [conservative management better than surgical management]in [terms of future morbidity and mortality]?
Clinical Scenario:
A 71 year old pleasant man presented to the Emergency Department complaining of dark urine, urgency, occasional dysuria, suprapubic pain and foul-smelling urine for 1 month. No frequency, haematuria or flank pain was reported. He has a past medical history of diverticulitis with lower gastro-intestinal bleeding in the past. You wonder whether all cases of colovesical fistula have to be managed surgically.
Search Strategy:
Medline 1950 to November 2009 using the OVID interface
Multifield Search
[Colovesical fistula] and [Management] LIMIT [English]
Multifield Search
[Colovesical fistula] and [Management] LIMIT [English]
Outcome:
17 papers were found of which 12 irrelevant. The remaining papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Diagnosis and management of colovesical fistula; six-year experience of 90 consecutive cases Garcea, G.;Majid, I.;Sutton, C. D.;Pattenden, C. J.;Thomas, W. M. 2006 USA | 90 consecutive patients with colovesical fistulae over a six-year period. | Restropective review/ Observational | Mortaliy and complications | 1 postoperative leak No mortality | Only involves surgical Management Biased as results from single surgeon No conservative management |
| Diagnosis and Surgical Management of Colovesical Fistulas Due to Sigmoid Diverticulitis. Sebastian Melchior, Dragan Cudovic,Jon Jones, Christian Thomas, Rolf Gillitzer, Joachim Thüroff 2009 USA | 49 patients who underwent surgery for colovesical fistula due to sigmoid diverticulitis | Observational | Morbidity Mortality & Recurrence | Postoperative morbidity was 8.2% (4 of 49) and mortality was 0%. During a median followup of 68 months there were no recurrent fistulas. | No conservative Management Short follow-up |
| Colovesical fistula – Is a surgical approach always justified? Solkar, M. H.;Forshaw, M. J.;Sankararajah, D.;Stewart, M.;Parker, M. C. 2005 USA | 50 patients with colovesical fistula over a 12-year period | Retrospective study | Morbidity and mortality | No significant difference between conservative and surgical Management in selected patients | Small sample |
| Management of colovesical fistula P. N. Rao, R. Knox, R. J. Barnard, P. F. Schofield 1987 UK | Review of 24 patients treated for colovesical fistula | Retrospective | Morbidity and mortality | No postoperative death Morbidity (5/23) – 1 PE, 1 Recurrence, 3 wound infection | No conservative Management |
| Conservative treatment of selected patients with colovesical fistula due to diverticulitis Amin M, Nallinger R, Polk HC Jr 1984 UK | Thirty patients with colovesical fistula due to diverticulitis in the past ten years | Retrospective | Mortality and morbidity | Six patients did not receive any of the standard operative therapies. Four of these patients were observed for three to 14 years with nonoperative management, with little inconvenience and without significant complications. Five of the 24 patients in the surgical group died in the postoperative period | Small conservative management group |
Author Commentary:
Only 2 studies directly answered the question. The evidence is variable with small sample data but points to the conclusion that in selected patients (benign cause), conservative Management should be offered as an option as there is no significant difference in disease-specific mortality in patients with benign colovesical fistula undergoing surgical intervention and patients treated conservatively.
Bottom Line:
Colovesical fistula occur due to various causes (Diverticulitis, colon cancer, crohn's among others). If of benign etiology, option of conservative Management should be offered to the patient when possible.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Garcea, G.;Majid, I.;Sutton, C. D.;Pattenden, C. J.;Thomas, W. M.. Diagnosis and management of colovesical fistula; six-year experience of 90 consecutive cases
- Sebastian Melchior, Dragan Cudovic,Jon Jones, Christian Thomas, Rolf Gillitzer, Joachim Thüroff. Diagnosis and Surgical Management of Colovesical Fistulas Due to Sigmoid Diverticulitis.
- Solkar, M. H.;Forshaw, M. J.;Sankararajah, D.;Stewart, M.;Parker, M. C.. Colovesical fistula – Is a surgical approach always justified?
- P. N. Rao, R. Knox, R. J. Barnard, P. F. Schofield. Management of colovesical fistula
- Amin M, Nallinger R, Polk HC Jr. Conservative treatment of selected patients with colovesical fistula due to diverticulitis