When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement

Table 1 Aetiological causes of enterovesical fistulae

Aetiology	Disease
Inflammatory (80%)	Diverticulitis
	Crohn’s disease
	Appendicitis
	Meckel’s diverticulum
	Tuberculosis
Malignancy (10%-20%)	Colorectal carcinoma
	Transitional call carcinoma
	Bladder squamous cell carcinoma
	Lymphoma
Iatrogenic (< 10%)	Radical prostatectomy
	Complex rectal resections
	Surgery post pelvic radiotherapy
	Palliative endoscopic stenting of
	Obstructing tumours

Table 2 Clinical presentation of enterovesical fistulae and reported frequencies

Presenting symptoms	Frequency (%)
Terminal pneumaturia	64-95[3,4,7,8]
Faecaluria	36-82.5[3,4,7,8]
Urine per rectum	15[2]
UTI (frequency, urgency, dysuria)	45-87.5[3,4,6-8]
Urosepsis	9.5-14[2,3]
Haematuria	22-30.4[3,7]
Abdominal pain	43-71.4[3,4,6]
Inflammatory mass	9.8-25[3,8]

UTI: Urinary tract infection.

Table 3 Diagnostic tests for investigating enterovesical fistulae and reported sensitivities

Diagnostic investigation	Sensitivity (%)
Urine microscopy	> 90[6]
Urine culture	> 90[6]
Charcoal test	100[38]
Poppy seed test	95-100[39]
Indocyanine green	92[36]
CT	61-100[2,33,40]
MRI	83.5-100[47,48]
Cystoscopy	46-60[3,49]
Colonoscopy	Up to 50[2]

CT: Computed tomography; MRI: Magnetic resonance imaging.

Table 4 Reported percent of single stage procedures performed and anastomotic leak rate per series

Ref.	Yr	Percent of single stage procedures (%)	Anastomotic leak rate (%)
Mileski et al[55]	1987	47	Not reported
Woods et al[50]	1988	Group A: 48; group B: 76	Group A: 7; group B: 2.4
Walker et al[5]	2001	68.5	0
Garcea et al[3]	2006	92	2.1
Melchior et al[40]	2009	100	0

Table 5 Summary of current evidences for bladder management in enterovesical fistulae resection

Ref.	Sample size (n)	Fistula type	Intra-operative bladder management	Cystogram	Catheter removal (d)	Urine leak (n)
Walker et al[5]	19	Mixed; inflammatory: 15; malignant: 3; traumatic: 1	Bladder defect not repaired; one partial cystectomy for locally advanced sigmoid tumour	Not specified	10	1; post partial cystectomy for locally advanced sigmoid tumour
Ferguson et al[62]	74	Benign	Bladder defect repaired if visible/palpable; simple closure: 15; curettage and suture: 4; omental flap: 5	Not performed	7	0
de Moya et al[66]	45	Benign	Simple bladder closure: 37; complex bladder repair: 8	19 performed; simple repair = 12; complex repair = 5; all negative	Early catheter removal (</= 7 d): 15; late catheter removal (> 7 d): 30	0
Dolejs et al[68]	89	Benign	Bladder repair: 66; simple closure: 48; partial cystectomy and closure: 18; omental flap: 36	67 performed; 4 positive	No bladder leak: 8 d (6-11); bladder leak: 36 (31-43)	5

Table 6 Summary of outcomes of enterovesical fistulae managed by laparoscopic resection

Ref.	Sample size	Enterovesical fistula (n)	Conversion to open (n)	Conversion rate (%)	Reason for conversion	Morbidity (%)
Kockerling et al[81]	304	6	1	16.6	Not stated	20
Franklin et al[82]	164	6	0	0		Not stated
Engledow et al[84]	31	31	9	29	6: Early conversion, 1: Poor visualisation; 1: Bleeding; 1: Inflammatory mass	13
Pokala et al[88]	43	13; Ileovesical: 4; colovesical: 9	All fistulae: 14; EVF: 2	All fistulae: 32.5; EVF: 15.4	Dense adhesions	All fistulae: 30; EVF: 15
Smeenk et al[90]	40	35				48
Marney et al[89]	15	15	5	33	3: Dense adhesions; 1: Inflammatory mass	20
					1: Friable tissue secondary to radiotherapy

EVF: Enterovesical fistulae.