ABSTRACT
Colovesical fistula (CVF) is an abnormal communication between the urinary bladder and the large intestine, usually sigmoid colon. Diverticulitis is the most common cause of CVF in most of the western studies, accounting for approximately 70% of cases. Diverticular CVF is uncommon in Asia. This case series shares the experience of six cases of diverticular CVF in Indian population. METHODSMedical records of six patients with diverticular colovesical fistulas during the period January 2016 - August 2019 were reviewed with regard to symptoms, diagnostic investigations, and management. Various aspects of the disease were analysed to determine the common features of colovesical fistula in our population. RESULTSAll patients with diverticular colovesical fistula were presented with urinary symptoms and none were aware about their existing colonic diverticulosis. Five out of the six cases presented with pneumaturia. Contrast enhanced computed tomography (CECT) abdomen detected sigmoid diverticulosis with vesical fistula in all cases. The most common site of fistula found on cystoscopy was on the left superolateral wall of bladder. All cases were operated as a single stage procedure including fistula repair, colonic resection, omental interposition with no temporary colostomy which provided an excellent surgical cure. CONCLUSIONSColovesical fistula secondary to diverticular disease has shown a rising incidence and can be effectively managed by a multidisciplinary team. It requires prompt diagnosis, adequate preoperative evaluation, perioperative care including bowel preparation, nutritional supplementation, appropriate antibiotics, and meticulous surgical skills allowing an elective one-stage approach.
ABSTRACT
Ureteric calculi are known to affect approximately 10 – 15% of the overall population. We wanted to determine as to whether silodosin can be used instead of DJ stenting in patients with uncomplicated ureteroscopic lithotripsy.METHODSWe selected 60 patients who underwent ureteroscopic lithotripsy (URSL) in the study group. They were divided into ‘stented group’ and ‘non-stented group on silodosin’. Patients with stone of 5 to 18 mm size with no intraoperative mucosal injury and no stricture were included in the study. All patients underwent surgery using an 8/9.8 Fr rigid ureteroscope, without ureteral dilation, with lithotripsy using an electro-hydraulic lithotripter, without extraction. A 4.5 Fr Double J stent was placed in the first group for three to four weeks. The patients underwent urine routine examination, plain x-ray KUB, and ultrasound abdomen before and after lithotripsy. Lower urinary tract symptoms and pain scores were recorded on 3, 7 and 15 days postoperatively. We compared mean operative time, emergency visits, rehospitalisation rates, and residual fragments between each group.RESULTSOut of 60 patients, 53.3% of patients had lower ureteric calculus, 30% had mid ureteric, and 16.7% had calculus at vesicoureteric junction. The mean calculus size on the left side was 10.23 mm, and on the right side was 10.33 mm. The mean intraoperative time was 33.23 minutes in stented and 29.9 minutes in the silodosin group (p< 0.003). Patients underwent assessment for flank pain, fever, and LUTS on postoperative days (POD) 3, 7 and 15. There was no statistically significant difference between the two groups though patients with DJ stent had more symptoms on inquiry. A total of 5 patients in the treatment groups were re-hospitalised, two patients (6.7%) in the stented group, and three patients (10%) in the silodosin group, out of which three patients (5%) required a secondary procedure which was not statistically significant. Three subjects treated with silodosin and 12 with the DJ stent in situ had residual fragments on POD 21 which was statistically significant (p 0.27).CONCLUSIONSPatients with uncomplicated URSL have similar recovery of renal function when treated with silodosin as compared to the placement of DJ stent. Treatment without stent with silodosin also has less irritative LUTS. We conclude that silodosin can be an alternative to DJ stent after uncomplicated ureteroscopic electrohydraulic lithotripsy, thereby reducing operative time and patient morbidity.