Early Removal of Foley Catheter after Sigmoid Colectomy for Diverticular Colovesical Fistula without Intraoperative Bladder Repair or Postoperative Cystography: Feasibility of a Quality Improvement Pilot Program

Abstract

Background: The treatment of colovesical fistula (CVF) due to diverticular disease is complex and imposes significant risk to the patient. Specifically, management of the bladder defect after fistula takedown is inconstant. In this quality improvement study, we report on the safety of early (< 7 days) urethral catheter removal without intraoperative or postoperative bladder imaging. Methods: Between 2008 and 2018, patients who were operated on for CVF due to diverticular disease were identified retrospectively. Medical records were reviewed to obtain patient characteristics, operative technique and findings, and postoperative outcomes. Results: Between 2008 and 2018, 17 patients with diverticulitis-induced CVF underwent fistula takedown. Bladder defects were only formally repaired if urothelium was visualized intraoperatively. Mean postoperative urethral catheterization was 5.5 days and bladder imaging was not performed intraoperatively or postoperatively. There were no urinary-related complications or mortalities, and mean follow-up was 249 ± 60 days. Conclusion: This quality improvement pilot study supports early catheter removal (< 7 days) and suggests bladder imaging may be unnecessary in select cases.