What is included in the long-term monitoring of enterovesical fistula?

Updated: Dec 24, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

After repair of fistulae caused by benign disease, the urinary catheter is left in place for 5-7 days or longer depending on the level of inflammation and size of the repair. The patient remains on appropriate antibiotics (ie, based on preoperative culture findings and sensitivity). At the next observation, a repeat urine culture with sensitivity is obtained. The author’s preference is to perform a gravity cystography with postdrainage films to confirm healing before catheter removal. Antibiotics are continued for 24-48 hours after catheter removal until the culture results are documented as negative.

Thereafter, the primary enteric process is treated as indicated, and the patient is periodically observed with urinalysis and cultures as indicated. Patients are usually aware of the symptoms of recurrence and should be encouraged to return early if they experience any indication of infection, pneumaturia, or fecaluria.

If cancer resection is performed, observational colonoscopy and CT scanning are obtained as indicated based on tumor histology findings and stage. Periodic cystoscopy may also be indicated because of the possibility of local recurrence in the detrusor muscle. Cystoscopy is especially important if the margin status of the tumor is questionable.

Certainly, any hematuria in the postoperative period should be carefully evaluated with upper tract imaging and cystoscopy.


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