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Session: ePoster: Benign Abdominal 3 (Sun225)

EP475 - Foley Catheter Management Following Surgery for Diverticular-Related Colovesical Fistula

Sunday, May 11, 2025
2:35 PM – 2:40 PM PT
Location: Monitor 1, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • KM

    Kevin McMahon, MD

    Fellow
    Lehigh Valley Health Network
    Allentown, Pennsylvania, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • WS

    William Sangster, MD

    Assistant professor
    Lehigh Valley Health Network
    Allentown, Pennsylvania, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • AL

    Ana Lozano, DO

    Physician
    AdventHealth
    Fort Lauderdale, Florida, United States

    Disclosure information not submitted.

  • KS

    Kyle Shaak, MPH

    Biostatistician
    Lehigh Valley Health Network
    Allentown, Pennsylvania, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Kevin McMahon, MD: This individual has no financial relationships with ineligible companies.
William Sangster, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Colovesical fistulas develop in approximately 3% of patients with diverticulitis [1]. Traditional management includes sigmoidectomy with or without bladder repair and post-operative continuation of the bladder catheter to ensure decompression for healing. Additionally, obtaining a cystogram prior to catheter removal has been a traditional approach. Anecdotally, more and more surgeons are foregoing this pathway in favor of a more streamlined approach of catheter removal prior to discharge with or without imaging. There is a paucity of research regarding the timing and protocol for catheter removal following sigmoidectomy for diverticular-related colovesical fistula.

Methods/Interventions: A retrospective chart review was completed for all patients who underwent surgery for diverticular-related colovesical fistulas performed between January 2014 and June 2024. All patients were followed for a minimum of one month after surgery. Data was collected including patient demographics, type of surgery, need for bladder repair, type of bladder repair (simple vs complex), catheter removal date, pre-removal imaging, urinary-related complications, length of admission, need for readmission, and any 30- day complications.

The type of bladder repair performed was recorded as a simple repair if two or fewer sutures were used in a single layer. Any repair that required three or more sutures or a multiple-layer closure was considered complex.

Results/Outcomes: 51 patients underwent resection for diverticular-related colovesical fistula during the study period. 49% were done robotically, 31% laparoscopically, and 20% were open. 23.5% of cases involved a bladder repair, while 76.5% of cases did not require a ladder repair. Looking at the 12 cases that underwent bladder repair, 75% were simple repairs and 25% were complicated repairs. The average stay after surgery was four days. 58.8% of patients underwent cystogram prior to foley removal. 30 cystograms were performed, and two were positive for bladder leak which were managed with continuation of the bladder catheter. No patient required catheter replacement after removal. 15.7% of patients had their catheter removed within three days of surgery, and none of these patients required catheter replacement.

Conclusion/Discussion: As hospital length of stay decreases following colorectal surgery, determining the appropriate time course for safe catheter removal is increasingly relevant. There is limited data to guide surgeons with this decision. Recent studies indicate that dogma requiring extended catheterization or cystogram are likely unnecessary although study sizes have been small [2-4]. This data further contributes to the idea that patients who undergo sigmoidectomy for colovesical fistula can safely undergo early catheter removal.