Rectovesical Fistula: Terminology and Clinical Significance
The correct term for a fistula between the rectum and the bladder is "rectovesical fistula" (RVF). 1
Definition and Characteristics
- A rectovesical fistula is characterized by an abnormal connection between the rectum and the bladder, creating a pathological tract between these two organs 1
- The pathognomonic clinical presentation includes pneumaturia (passage of air in urine) and fecaluria (passage of fecal material in urine) 1
- Recurrent urinary tract infections are also a common presenting manifestation of rectovesical fistulae 1
Etiology
- The most common causes of rectovesical fistulae include diverticulitis, Crohn's disease, colorectal or pelvic malignancies, radiation therapy, iatrogenic injury, and postoperative complications 1
- Iatrogenic causes are particularly significant, with surgical procedures like radical prostatectomy being a notable risk factor 2
- In a historical series of 109 patients with colovesical or rectovesical fistulas, inflammation (either diverticulitis or Crohn's disease) was the cause in 67% of cases 3
Diagnostic Imaging
- CT with intravenous contrast is commonly used to diagnose rectovesical fistulae, with a diagnostic sensitivity of 76.5% for fistula detection and 94.1% for defining the etiology 1
- Water-soluble contrast should be placed in the bowel or bladder to opacify fistulous tracts during imaging studies 1
- Cystography has shown high detection rates (90%) for enterovesicular fistulae in some studies, compared to 75% detection with contrast enema 1
- MRI pelvis with IV contrast provides superior contrast resolution for evaluating fistulous tracts and is particularly useful for detecting active inflammation 4
Clinical Implications
- Rectovesical fistulae require specific treatment approaches and often necessitate a multidisciplinary approach 1
- The condition can significantly impact quality of life and may lead to serious complications if left untreated 2
- Treatment options range from conservative management to surgical repair, with the approach determined by the size, location, and etiology of the fistula 5
- Robotic surgical approaches have shown promising results for complex rectovesical fistula repairs, particularly in cases where conventional surgery may be challenging 6
Terminology Distinction
- It's important to distinguish rectovesical fistulae from other types of fistulae such as rectovaginal (between rectum and vagina), colovesical (between colon and bladder), or ureterovaginal (between ureter and vagina) fistulae, as they have different etiologies, presentations, and management approaches 4, 7, 8