Entero-neovesical fistula after radical cystectomy and orthotopic ileal neobladder: A report of two cases requiring surgical management

Abstract

Conservative treatment of entero-neovesical fistula can be attempted only in patients with small openings in the small bowel and no systemic symptoms. In all other cases, surgical treatment with bowel resection and either closure of the neobladder opening or undiversion should be the preferred option.

Laparoscopic treatment of entero-neobladder fistula after radical cystectomy

“…The most typical presentation of entero-to-neobladder fistula is faecaluria, pneumaturia or recurrent urinary tract infections and the diagnosis is usually confirmed by contrast-enhanced abdomino-pelvic CT [ 1 , 3 , 4 ].…”

“…Conservative treatment could be the first option if the patient is stable and the fistula is small, but surgical treatment is usually required and includes resection of the affected bowel tract and reconstitution of bowel transit [ 1–3 ]. In this case, as the conservative treatment with low-residue diet and prolonged transurethral urine drainage does not work, we proceed to minimally invasive surgical treatment.…”

“…Entero-neovesical fistula is a rare complication of orthotopic ileal neobladder after radical cystectomy occurring in <2% of cases [ 1 , 2 ]. The most typical presentation is faecaluria, pneumaturia or recurrent urinary tract infections [ 1 ]. Diagnosis is usually confirmed by contrast-enhanced abdomino-pelvic computed tomography (CT) [ 1 , 3 , 4 ].…”

“…The most typical presentation is faecaluria, pneumaturia or recurrent urinary tract infections [ 1 ]. Diagnosis is usually confirmed by contrast-enhanced abdomino-pelvic computed tomography (CT) [ 1 , 3 , 4 ]. Surgical treatment is usually required and includes open resection of the affected bowel tract and reconstitution of bowel transit [ 1 ].…”

Use of ileal bypass in the surgical management of two rare cases of ileal-neobladder fistula in patients who underwent radical cystectomy

“…A non-trivial risk of further bowel or neo-bladder injury exists, and rerouting the neobladder into the ileal conduit is sometimes needed. 2,3 If the fistula can be closed with a simple surgical technique, this will reduce the frequency of patients requiring conservative treatment for an extended period. We report a novel, safe procedure to close ileal neovesical fistulas without extensive adhesiolysis using an NK-stapler (ENDOPATH® ENDOCUTTER ETS; Johnson & Johnson, Cincinnati, OH, USA).…”