Cystogram Before Removal of Foley Catheter After Repair of Colovesical Fistula

Colovesical fistulas are well-recognized but relatively uncommon pathology to both the
general and colorectal surgeon. It is a complication arising from an underlying primary acute
to chronic inflammatory process. Although colovesical fistulas are uncommon, they are
associated with significant morbidity, affect quality of life, and may lead to death, usually
secondary to urosepsis. Early diagnosis and management is essential.

The purpose of the study is to determine the objective use of cystographic evaluation on
postoperative day two to guide early Foley catheter removal post colovesical fistula
takedown. The hypothesis is that a cystogram showing no extravasation of contrast on
postoperative day two will predict safe removal without increased morbidity.

This is an uncontrolled, single arm trial. Patients who meet criteria to undergo either
minimally invasive or open colovesical fistula takedown with sigmoid colectomy, without
evidence of the need for bladder repair will be eligible to participate. An indwelling Foley
catheter is placed intraoperative and continued postoperative. All patients who consent to
participate would undergo a cystogram on postoperative day two. The cystogram will be
conducted by a radiologist and technician well-trained in the techniques and interpretation
of the study. The colorectal surgery enhanced recovery protocol will be followed on all
patients with the exception of the cystogram being conducted on post-op day two. If there is
no evidence of extravasation of dye is seen on the cystogram the Foley catheter will be
removed. Patients will be monitored closely following catheter removal to ensure
self-diuresis.