Bladder Fistulectomy

Why is it done?

• Bladder intestinal fistula is an abnormal communication between bladder and bowel.
• Causes:
  • Previous surgery
  • Diverticular disease
  • Colonic cancers
  • Radiation

• This procedure is performed when all other treatment options are exhausted with recurrent symptoms and persistent pneumaturia and fecal uria due to a colonic-vesical fistula
• Symptoms include:
  • pneumaturia (air in urine),
  • fecal Uria (stool in Urine),
  • recurrent bladder infections.
• This surgery is usually done with a colo-rectal surgeon and may involve a partial bowel resection, possibly a temporary loop ileo/colostomy (diversion of bowel with an external bag)

How is it done?

• Patients will receive a general anaesthesia,  unless contra-indicated.
• Prophylactic antibiotics are given.
• An indwelling catheter is placed, and the bladder is filled with saline.
• Open procedure or robotic assisted.
• A lower midline incision is made, or robotic ports are placed
• The retropubic space of Retzuis is entered
• The bladder is resected away from the bowel.
• The affected piece of bowel may be resected with either a temporary diversion of the bowel to a bag or a primary anastomosis depending on the colo-rectal surgeon’s findings
• The affected part of the bladder may be resected. The bladder is closed in 2 layers over a 3-way irrigation catheter
• Omentum will be placed between bladder and bowel where at all possible to limit recurrences
• A drain is left for a couple of days
• You may have continuous Antibiotics over the next few days.
• You have a few days stay in ICU or high care facility

Complications

Side–effects

• Rarely blood loss requiring a blood transfusion.
• Infection/ sepsis
• Prolonged hospital stays.
• Urine leak requiring prolonged catheterization.
• Bowel leak etc.
• NB! Each person is unique and for this reason symptoms vary!

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Wes Bladder Fistulectomy

Copyright 2019 Dr. Jo Schoeman