[The diagnosis and treatment of a postcystectomy enteroneovesical fistula]

Actas Urol Esp. 1999 Jul-Aug;23(7):573-8.
[Article in Spanish]

Abstract

Fistulae between the reservoir of the continent urinary bypass and the intestinal tract are uncommon and difficult to diagnose. To ascertain the clinic presentation, diagnosis and treatment of post-cystectomy enteroneovesical fistula due to a bladder tumour, 258 cases of radical cystectomies performed over a 6-year period were reviewed. Early and late fistulization were defined as those diagnosed before and after 3 months from surgery. Six male and one female patients, mean age 60.5 years, were included in the study. Fecaluria was the most common clinical presentation occurring in 85.7% cases. Three and two patients, respectively, were given neoadjuvant radiotherapy and adjuvant chemotherapy, fistula was early in 3 (42.8%) and late in 4 (57.2%) patients. Contrast examination of the neobladder (neocystogram) was the most effective diagnostic method. Conservative treatment with a low waste diet and continuous urinary drainage was used in 4 patients; this was fully effective in two patients with early fistula. Surgical treatment was effective in 100% cases. Fistula etiology appears to be develop from multiple reasons, radiotherapy being the major predisposing factor. A neocystogram should be performed in all patients with a suspicious enteroneovesical fistula. When no evidence of tumoral recurrence, poor nutritional status, or stoma obstruction in present and the fistula is early, treatment should be approached with a low-waste diet and continuous urinary catheterization. Surgery is indicated in cases with late fistulization and after failure of conservative therapy.

MeSH terms

  • Aged
  • Colon, Sigmoid / surgery
  • Combined Modality Therapy
  • Cystectomy*
  • Feces
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / therapy
  • Postoperative Complications / urine
  • Radiography
  • Urinary Bladder / diagnostic imaging
  • Urinary Bladder / surgery
  • Urinary Bladder Fistula / diagnosis*
  • Urinary Bladder Fistula / therapy
  • Urinary Bladder Fistula / urine
  • Urinary Bladder Neoplasms / complications
  • Urinary Bladder Neoplasms / surgery
  • Urinary Diversion*