Vesicoenteric fistulas.

Vesicoenteric fistulas are a challenge to both the urologist and the general surgeon. Awareness of the possibility of an enteric origin of recurrent urinary symptoms should help us prevent the long delays in diagnosis. Thorough and accurate preoperative evaluation will help us make the proper selection as to a one stage or multistage repair. There is room for both in the surgeon's armamentarium, and a wise decision can produce excellent results as seen in this series. When the fistula is of malignant origin, the long-term prognosis remains poor, as it is for any colonic carcinoma extending beyond the serosa and involving a contiguous organ. Fistulas secondary to radiation necrosis and recurrent tumor have an extremely poor outlook with some palliation afforded by a diverting colostomy or a Hartman procedure. Patients with fistulas due to diverticular disease and, to a lesser extent, Crohn's disease can look forward to complete correction with low mortality and morbidity.