Benign Prostatic Hyperplasia Can Be Protective

A Case Study

Jessica Wilkinson, MBChB; Jonathan Bird, BSc, PA; Edmund Leung, MBBS, MRCS, DMSc, FRCS

Disclosures

Urol Nurs. 2020;40(5):248-250. 

In This Article

Discussion

A colovesical fistula is an abnormal connection between the colon and the bladder. Colovesical fistulae mostly (65% to 75%) occur in patients with complicated diverticulitis (Yagi et al., 2014). Other causes include Crohn's disease, malignancy, radiation, trauma, and foreign bodies. Fistulae are caused by raised intraluminal pressure and segmentation of the colon from abnormal motility, resulting in mucosa herniation through muscle layers at certain weak points (Giovanni et al, 2014). Pneumaturia and urosepsis are present in 50% to 70% of cases (Salgado-Nesme et al, 2016).

The preferred management of a colovesical fistula remains surgical, involving removal of the fistula, bladder wall repair, and colectomy through a one-stage technique (Oomen et al., 2006). Usually, the approach is open because there is a high rate of conversion from laparoscopic to open – approximately 25% (Janes et al., 2006). Surgery is not without risk (mortality and morbidity rates of 16.7% and 71.1%, respectively, due to adhesions and post-operative abscess) (Golabek et al., 2013). This has remained unchanged despite advances in surgical techniques, antibiotic treatment, and high dependency care (Haas et al., 2015). For those deemed unfit for surgery or with minimal symptoms, a conservative approach can be taken. This would include low-residue diet, catheterization with or without regular irrigation, and long-term antibiotic therapy. However, conservative management has been linked to significant morbidities, progression of malignant vesicular disease, and the septic effect of enterovesical fistulas (Leicht et al., 2012; Ool & Wong, 2009).

Normally, the higher intraluminal pressure gradient of the colon than the bladder will encourage faecal matter to pass from the colon into the bladder. Consequently, this leads to symptoms of recurrent urosepsis from colonic flora, pneumaturia, and faecuria. Prostatic enlargement increases the intravesical pressure, reversing the colonic pressure gradient and forcing urine to flow into the bowel. With a continual opening into the bowel, this becomes a free-flowing tract for the urine to pass into the colon, limiting the opportunity of bacterial colonization of the bladder and urine, therefore, reducing the rate of urosepsis.

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