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EARLY FOLEY CATHETER REMOVAL AFTER SIGMOID COLECTOMY FOR DIVERTICULAR COLOVESICAL FISTULA
Anthony J. Carden*2, Dan Eisenberg1,2
1Surgery, Stanford School of Medicine, Palo Alto, CA; 2Surgery, Palo Alto VA HCS, Palo Alto, CA
Introduction:
Colovesical fistula is an uncommon complication of diverticulitis that can present with recurrent urinary tract infection, pneumoturia and/or fecaluria. Laparoscopic sigmoid colectomy is the treatment of choice, yet there is no consensus regarding intraoperative and postoperative management of the bladder. Here we describe our experience in sigmoid colectomy, with early (≤ 7 days) removal of Foley catheter after surgery.
Methods:
This is a retrospective review of patients undergoing sigmoid colectomy for complicated diverticulitis with colovesical fistula at a single Veterans Affairs (VA) hospital. All patients had preoperative CT scan to confirm the diagnosis. Preoperative antibiotic and mechanical bowel preparation were given as per institutional protocol, and preoperative ureteral stents were placed in all patients. During surgery the bladder was repaired selectively, only when a gross defect was seen. Patients with complex bladder repairs were excluded. The electronic health record was reviewed to determine operative technique, duration of Foley catheter after surgery, length of hospital stay, and early follow-up.
Results:
Between 2008 and 2017, 16 patients underwent elective sigmoid colectomy for colovesical fistula. Of these, 93.8% (n=15) were men, with a mean age of 63 years. At presentation 75% (n=12) had recurrent urinary tract infections, while 75% (n=12) and 43.8% (n=7) reported pnemoturia and fecaluria, respectively. Operative technique was total laparoscopic in 50% (n=8), hand-assisted laparoscopic surgery in 25% (n=4), open in 18.8% (n=3), and robot-assisted in one patient. Primary colorectal anastomosis was performed in all but one patient (93.8%). Bladder repair was performed in two patients (12.5%). No specific provocative maneuvers were performed, such as filling bladder with methylene blue, to identify bladder involvement.
Foley catheters were removed after mean 5.5 ± 1.3 days; patients were then followed clinically and allowed to spontaneously void. Postoperative bladder imaging (cystography) was not performed in any of the patients. Mean length of hospital stay was 5.9 ± 1.6 days. Mean surgery clinic follow-up was 249 ± 60 days. There were no urinary complications in the follow-up period.
Conclusion:
Early (≤7 days) removal of Foley catheter is safe after sigmoid resection for complicated diverticulitis with colovesical fistula. Routine bladder imaging is not necessary and can be reserved for patients requiring complex bladder repair.
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