Nonsurgical management may be an option in selected cases of ColoVesical fistula(CVF)who cannot undergo surgery or have other colonic diseases which make surgery a unsuitable choice.It may be preferred by some patients who choose not to undergo surgery.CVF is seen in patients of Diverticulitis,Inflammatory bowel disease like Crohn's Disease or abdominal malignancies .Surgical excision would be the first choice if it is practical.However some patients tend to do well even on conservative surgery,the fistula may close spontaneously in about 50 % of such patients.If the patient is asymptomatic,regular monitoring for UTI by urine examination and subsequent C/S, intermittent antibacterial therapy may cause surgery to be deferred.The risk of recurrent pyelonephritis and subsequent kidney damage is low if regular monitoring is done. Newer agents like Infliximab help in reducing the inflammation of the colon and may promote closure of the fistula. http://www.ncbi.nlm.nih.gov/pubmed/16108883 would be a article of interest.
the problem I have with surgery is that the fistula is close to where the kidney tubes come into the bladder and this makes the surgery complicated and the outcome a possible bag for urine. My view is that trying conservative management would be a reasonable option for my situation. Would you have an opinion on this?