Removal of Indwelling Urinary Catheter Two Days After Colovesical Fistula Repair: a Single-Arm Prospective Trial

Abstract

BackgroundColovesical fistulas are uncommon but associated with significant morbidity and reduced quality of life. In cases with diverticular etiology, surgical management involves single-stage colonic resection with anastomosis and simple or no bladder repair. No single approach to postoperative bladder management has been widely accepted. Although historically a Foley catheter remained in place for about 2 weeks, elevated risk of the attendant complications has motivated exploring shorter durations. This study examined the feasibility and safety of removing the Foley catheter on postoperative day two. MethodsPatients with colovesical fistula due to diverticular disease undergoing colectomy with simple or no bladder repair were enrolled in this single-arm prospective trial conducted at a large community health system. The primary outcome was removal of the Foley catheter on postoperative day two after negative cystogram without re-insertion prior to hospital discharge. Secondary outcomes were complications after Foley catheter removal and hospital length of stay. Ninety-five percent confidence intervals were calculated for the outcomes. ResultsTwenty-four patients were enrolled. About half (54%) of procedures were open, with 33% requiring simple bladder repair. Ninety-six percent (95% confidence interval, 79–99%) of patients had their Foley catheter removed on postoperative day two after a negative cystogram. There were no complications. Mean (range) hospital length of stay was 4.3 (2–6) days. DiscussionFoley catheter removal after negative cystogram on postoperative day two appears to be feasible and safe in the setting of diverticulitis-related colovesical fistula repair. Further research on a larger number of patients should confirm these findings.