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Minerva Urology and Nephrology 2022 August;74(4):400-8

DOI: 10.23736/S2724-6051.21.04750-9


lingua: Inglese

Management of colovesical fistula: a systematic review

Maurizio ZIZZO 1, 2 , David TUMIATI 1, Maria C. BASSI 3, Magda ZANELLI 4, Francesca SANGUEDOLCE 5, Francesco PORPIGLIA 6, Cristian FIORI 6, Davide CAMPOBASSO 7, Carolina CASTRO RUIZ 1, 2, Franco A. BERGAMASCHI 8, Umberto V. MAESTRONI 7, Giuseppe CARRIERI 9, Luigi CORMIO 9, 10, Federico BIOLCHINI 1, Andrea PALICELLI 4, Alessandra SORIANO 11, 12, Romano SASSATELLI 13, Stefano ASCANI 14, 15, Valerio ANNESSI 1, Alessandro GIUNTA 1

1 Unit of Surgical Oncology, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy; 2 University of Modena and Reggio Emilia, Modena, Italy; 3 Medical Library, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy; 4 Unit of Pathology, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy; 5 Unit of Pathology, University Hospital of Foggia, Ospedali Riuniti di Foggia, Foggia, Italy; 6 School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy; 7 Unit of Urology, University Hospital of Parma, Parma, Italy; 8 Unit of Urology, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy; 9 Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; 10 Department of Urology, Bonomo Teaching Hospital, Andria, Barletta-Andria-Trani, Italy; 11 Unit of Gastroenterology, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy; 12 Department of Pathology, Case Western Reserve University, Cleveland, OH, USA; 13 Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy; 14 Unit of Hematology, CREO, Hospital of Perugia, University of Perugia, Perugia, Italy; 15 Unit of Pathology, S. Maria di Terni Hospital, University of Perugia, Terni, Italy

INTRODUCTION: Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management.
EVIDENCE ACQUISITION: We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature.
EVIDENCE SYNTHESIS: The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. Four percent anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68-month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8-49%, 0-63% and 1.2%, respectively.
CONCLUSIONS: CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and reanastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.

KEY WORDS: Fistula; Diverticulitis; Surgical procedures, operative

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