Fact-sheet: Colo vesical fistula
Updated on 09/17/2021 at 12:16 PM
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Definition
Complication of surgical treatment for localized prostate cancer.
Rare, incidence: 0.8-3.6% after prostatectomy, 0.3-3% after brachytherapy, 6% after radiotherapy.
Unrecognized rectal injury after prostatectomy, or occurring 6 months to 20 years after prostatic radiotherapy or brachytherapy
Clinical features
Voiding disorders: fecaluria, pneumaturia, leakage of urine through the rectum, recurrent urinary tract infections
Radiography
Retrograde and voiding urethrocystography:
essential passage of contrast material between the ureter and rectum with rectal opacification: (morphology of the rectourethral fistula)
CT
Rectal opacification: passage of contrast material into the bladder.
Bladder opacification: passage of contrast material into the rectum.
Rectovesical fistulous tract
Management
No official recommendation on management.
Spontaneous closure is rare.
Established fistula = surgical repair is essential!
No consensus regarding surgical management strategy (etiology, clinical presentation, surgeon...).
York-Mason technique most commonly used, providing direct access to the rectourethral fistula via a posterior transsphincteric approach.
Conservative treatment with colostomy and bladder drainage allows fistula closure in 1 out of 4 cases