Although uncommon, colovesical fi stula creates signifi cant morbidity, and many patients wait months to receive a correct diagnosis and treatment. Most cases are in older men who have diverticular disease, Crohn disease, cancer, or iatrogenic injury, and some of these associations may have occurred in the patient's distant past and may not be immediately apparent. Since the incidence of diverticulitis in elderly patients is increasing and, in a separate trend, more patients are undergoing bladder instrumentation, we need to suspect this diagnosis when evaluating any patient with urinary tract infection, especially a man with prolonged symptoms refractory to conventional treatments. KEY POINTSColovesical fi stula is challenging to diagnose, as the signs and symptoms can resemble those of simple urinary tract infection.There is currently no consensus on how best to diagnose colovesical fi stula.Urinalysis and urine culture offer no specifi c clues about anatomy and demonstrate only bacteriuria in more than 85% of cases.Disclaimer: The statements and opinions expressed in this review are those of the authors and do not represent an offi cial position of any institution.
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