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Vakul Aren
Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3366
Experience:  MBBS,DTM&H,30 years of experience
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I have a colovesical fistula connecting my colon and bladder.

Resolved Question:

I have a colovesical fistula connecting my colon and bladder. I have had a catheter for eight weeks and then six weeks without. It is much better but still present. I have been reading about long term conservative management when surgery is a problem and I am wondering if any doctors on line have experience with this.
Submitted: 1 year ago.
Category: Medical
Expert:  Vakul Aren replied 1 year ago.

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.

Customer: replied 1 year ago.

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?

Expert:  Vakul Aren replied 1 year ago.
In the hands of a experienced Urologist that should not be a big problem.Use of Infliximab injected locally has been tried in patients ,it has resulted in promoting spontaneous closure of the fistula in some patients.The opinion of your treating Urologist would be the best as he is aware of the exact location of the fistula and other complications in your case.
Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3366
Experience: MBBS,DTM&H,30 years of experience
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