Urologic aspects of vesicoenteric fistulas.

The classic symptoms of pneumaturia and fecaluria were not present in many of 100 patients (male to female ratio of 2.4) with vesicoenteric fistulas who presented with fever, abdominal mass or cystitis. There was a urinary tract infection in 95 per cent of the patients studied but only 29 per cent had a mixed infection. Roentgenographic studies suggested a fistula in 18 to 35 per cent of those studied but cystoscopy was singularly the most successful diagnostic technique (79 per cent). Inflammatory bowel disease in 63 per cent and colorectal adenocarcinoma in 16 per cent were the most common etiologic factors. Bladder carcinoma was the cause in only 5 per cent. Treatment consisted of single or multistage surgical repair of fecal diversion in 95 operable patients, with gratifying results, and of expectant management in the 5 inoperable patients.