From the Research
The management of a rectovesical fistula typically requires surgical intervention after initial stabilization and control of infection. Initial management includes urinary drainage with a Foley catheter, bowel rest, antibiotics (such as ciprofloxacin 500mg twice daily and metronidazole 500mg three times daily for 7-14 days), and nutritional support. Definitive treatment involves surgical repair, which may be performed in one or multiple stages depending on the patient's condition and fistula complexity.
Key Considerations
- The most common surgical approaches include transabdominal repair with fistula excision, primary closure of both rectum and bladder, and interposition of healthy tissue (such as omentum) between the repaired organs.
- For patients with inflammatory bowel disease or radiation-induced fistulas, a temporary diverting colostomy or ileostomy may be necessary to allow the repaired area to heal.
- In cases of malignancy-related fistulas, treatment of the underlying cancer is essential.
- Minimally invasive approaches like laparoscopic or robotic-assisted repairs are increasingly used in suitable candidates, as seen in a study published in 2017 1.
Postoperative Care
Postoperatively, the urinary catheter is typically maintained for 7-14 days until cystography confirms watertight closure. Recovery requires close monitoring for recurrence, with success rates of 85-95% for properly performed surgical repairs. A study from 2015 2 demonstrated the effectiveness of an algorithm-based multidisciplinary treatment approach for rectourethral fistula, with a healing rate of 90% and recurrence rate of 0%.
Additional Treatment Options
Other treatment options, such as the use of fibrin sealant, have been explored in the management of colorectal fistulas, as reported in a study from 2002 3. However, the primary approach remains surgical intervention, with the choice of technique depending on the individual patient's condition and the complexity of the fistula.