Diagnostic yield of cystography after sigmoid resection for colovesical fistula due to complicated diverticulitis.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-10-08 DOI:10.1007/s10151-025-03216-1

N P van der Beeke, M G Stevenson, E J A Steller, A D van Dalsen, L P W Witte, H L van Westreenen

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引用次数: 0

Abstract

Background: Sigmoid resection is the preferred treatment for diverticular colovesical fistula. To prevent postoperative intra-abdominal urine leakage, an indwelling urinary catheter (IUC) is placed, with cystography sometimes performed before IUC removal. Given the absence of well-defined postoperative guidelines, this study investigates diagnostic yield of cystography and IUC use.

Methods: We conducted a single-center retrospective cohort study of patients who underwent elective sigmoid resection for diverticulitis (2010-2023). Patients with colovesical fistula were identified. Data on patient characteristics, operative details, complications, postoperative IUC duration, and cystography use were analyzed.

Results: Sigmoid resection was performed in 204 patients, 55 (27.0%) of whom had a colovesical fistula. Simple bladder repair was performed in 18 (32.7%) patients, while four (7.3%) patients underwent complex repair. The remaining 33 (60%) patients did not undergo vesical closure. All 55 patients retained an IUC postoperatively, of whom 37 (67.3%) underwent cystography before IUC removal. Cystography was normal in 34 (91.9%) patients. In three patients, extravesical contrast was observed, resolving with extended IUC duration (7, 14, and 14 days, respectively). In two of three cases, extravesical contrast occurred following complex bladder repair. Median IUC duration did not differ significantly between those with and without cystography (7 versus 6 days, p = 0.104). However, median hospital stay was significantly longer in patients with fistula compared to patients without fistula (5 versus 4 days, p = 0.040).

Conclusions: Postoperative cystography may not be necessary in patients with diverticular colovesical fistula without or after simple bladder repair. However, cystography should be considered if complex repair has been performed.

Trial registration number: 20231001, 28 November 2023.

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乙状结肠切除术后膀胱造影对复杂性憩室炎膀胱瘘的诊断率。

背景：乙状结肠切除术是治疗憩室膀胱瘘的首选方法。为了防止术后腹内尿漏，放置留置导尿管（IUC），有时在取出IUC之前进行膀胱造影。鉴于缺乏明确的术后指南，本研究探讨膀胱造影和IUC使用的诊断率。方法：我们对2010-2023年接受选择性乙状结肠切除术治疗憩室炎的患者进行了一项单中心回顾性队列研究。发现膀胱瘘患者。分析了患者特征、手术细节、并发症、术后IUC持续时间和膀胱造影使用的数据。结果：204例患者行乙状结肠切除术，其中55例（27.0%）有膀胱瘘。单纯膀胱修复18例（32.7%），复合膀胱修复4例（7.3%）。其余33例（60%）患者未进行膀胱闭合。55例患者术后均保留了IUC，其中37例（67.3%）在取出IUC前进行了膀胱造影。34例（91.9%）患者膀胱造影正常。在3例患者中，观察到体外显影剂，随着IUC持续时间的延长（分别为7、14和14天）而消退。三例中有两例在复杂膀胱修复后发生了膀胱外造影剂。有膀胱造影和没有膀胱造影的患者中位IUC持续时间无显著差异（7天和6天，p = 0.104）。然而，瘘患者的中位住院时间明显长于无瘘患者（5天对4天，p = 0.040）。结论：单纯膀胱修复或未做膀胱修复的憩室膀胱瘘患者术后膀胱造影可能是不必要的。然而，如果进行了复杂的修复，则应考虑膀胱造影。试验注册号：20231001,2023年11月28日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.