Disease Description (Causes and Symptoms)
- Definition and pathophysiology: A vesicointestinal fistula is a condition in which an abnormal tube (passage) forms between the small intestine and bladder, allowing small-intestinal contents to flow into the bladder. A fistula forms when localized inflammation or a tumor, radiation injury, postoperative adhesions, or other conditions invade the walls of the intestine and bladder.
- Main causes: Localized enteritis (e.g., diverticulitis), Crohn’s disease, small-intestinal tuberculosis, small-intestinal cancer or malignant lymphoma, bladder tumors, complications after pelvic or abdominal surgery, injury after radiation therapy, trauma, and others.
- Main symptoms: Pneumaturia (passage of air during urination), fecaluria or contaminated urine (fecal matter in the urine), recurrent cystitis or urinary tract infections that do not respond well to treatment, changes in bowel habits (diarrhea or constipation), hematuria, and systemic symptoms (fever, generalized weakness), among others.
Treatment Methods
- Diagnostic approach: Abdominal and pelvic computed tomography (CT) to identify the fistula and causative lesions, barium contrast studies (intestinal contrast imaging), fistulography, enteroscopy or colonoscopy, cystoscopy (examination and biopsy), urine culture, and other tests are needed.
- Standard treatment:
- Surgical treatment is the standard: Treatment consists of fistula excision and resection of the involved segment of the small intestine (partial bowel resection and reanastomosis). The bladder is treated with partial cystectomy or, if necessary, total cystectomy and reconstruction (or temporary or permanent urinary diversion).
- Preoperative optimization: Infection control (antibiotics), improvement of nutritional status (parenteral nutrition if necessary), reduction of intestinal contents (fasting and bowel preparation), and other measures.
- Conservative treatment: In rare cases, temporary observation, antibiotics, and urinary catheter placement may be attempted to relieve symptoms in patients with small fistulas or those at high risk from surgery. However, recurrence is common, and surgery is often the definitive treatment.
- Medication: Appropriate antibiotics for infection control (according to culture results) and pain control.
- Lifestyle management and precautions:
- Seek medical attention immediately if symptoms of a urinary tract infection occur (fever, painful urination, cloudy urine, or foul odor).
- Avoid smoking before and after surgery, maintain adequate nutrition (protein and calorie supplementation), and monitor the wound and urination status after surgery.
- Risk of complications: Persistent infection, pyelonephritis or sepsis, impaired intestinal or bladder function, fistula recurrence, malnutrition, and others.
- Prognosis varies depending on the cause (benign inflammatory disease versus malignant tumor) and general condition. The postoperative prognosis of inflammatory disease is generally favorable, while cases caused by malignancy may have a poor prognosis.
Outpatient Visit Checklist (Including Items to Bring and Example Questions)
- Items to bring to the visit:
- A list of currently used medications (including prescriptions, OTC medications, and supplements)
- Records of previous surgeries, radiation therapy, and hospitalizations
- Copies or CDs of recent test results (CT, ultrasound, blood tests, urine tests, colonoscopy, and others)
- A symptom diary (date symptoms began, whether pneumaturia or fecaluria occurred, fever, changes in bowel habits, and others)
- Items to check before the appointment (self-check):
- The smell and color of the urine, whether it contains air, and whether there is pain during urination
- Recent weight changes and whether fever or chills are present
- A history of intestinal diseases (Crohn’s disease, diverticulitis, and others) or radiation therapy
- Important information to tell the doctor first:
- A history of recent pelvic or abdominal surgery or radiation therapy
- Immunocompromised status (such as use of anticancer drugs or steroids)
- Allergies (especially antibiotic allergies)
Examples of General Questions to Ask the Doctor
- "What do you think is the cause of my fistula? What additional tests or diagnoses are needed?"
- "Why is surgery recommended, and what results can be expected from the surgery?"
- "What complications are likely before and after surgery, and what measures can be taken to prevent them?"
- "What should I be careful about regarding my lifestyle or diet during treatment?"
Examples of Condition-Specific Questions
- "In my case (for example, if I have a history of Crohn’s disease), how likely is the fistula to recur, and what additional treatment (medical management) can reduce the risk of recurrence?"
- "If part of my bladder needs to be removed during surgery (partial cystectomy), how might my bladder function and urination pattern change? Will urinary tract reconstruction or a urinary diversion be necessary?"