Ureteral Stent Insertion Research Articles

A rare presentation of acute kidney failure due to retroperitoneal fibrosis as a result of gastric linitis plastica: a case-based review

This case study details the experience of a 52-year-old Dutch man, with a 4-month history of epigastric pain and weight loss, who was presented to a urology team and found to have rapidly deteriorating renal function with bilateral hydronephrosis. This prompted his admission to hospital for insertion of bilateral JJ ureteral stents. However, the patient's kidney function continued to worsen despite relief of the obstruction. He became increasingly oliguric and was referred to the renal service. Retroperitoneal fibrosis with acute kidney injury resulting from both obstruction and compression of the urinary system was suspected. Treatment with high-dose steroid was initiated. Shortly after, the patient's urine volume began to increase and his kidney function improved drastically. This avoided the need for dialysis. A month after discharge, the patient was diagnosed with poorly differentiated adenocarcinoma cells of the stomach, a diagnosis consistent with linitis plastica.

Poster 14 - Fluoroscopic-guided retrograde transurethral ureteric stent insertion - technical challenges and solutions

Poster 14 - Fluoroscopic-guided retrograde transurethral ureteric stent insertion - technical challenges and solutions

Ureterovaginal Fistula: An Audit of Treatment Options in an Underdeveloped Area of Pakistan

Throughout 2021, we were requested to assess and treat 10 women who had suffered ureterovaginal fistulas after caesarean sections at separate remote hospitals. We describe our experiences diagnosing and treating uninsured patients at a hospital with minimal resources. A three-swab test was conducted on each of the 10 patients, and an abdominal and pelvic ultrasound was utilised to help locate the afflicted ureter. The patient had transvesical ureteral stent insertion. The stent was removed after two weeks. No wetness in the 10 patients.In the middle of today's complicated health care system, we must continuously remind ourselves of the common develops after a caesarean section and a well-known and simple diagnostic technique management in resource-poor communities

Outpatient before inpatient treatment?-Reality of care and economic analysis for minor urological interventions in Germany between 2013 and 2018

Although outpatient provision of services is economically desirable, many minor urological interventions in Germany are currently carried out on an inpatient basis. The aim of our study is to investigate whether the current health policy framework contributes to more outpatient treatment. We used asample of 4.9million anonymous, insured persons representative according to age and region provided by the Institute for Applied Health Research (InGef GmbH). We report extrapolations for the number of outpatient and inpatient services throughout Germany between 2013 and 2018. In addition, we performed an economic analysis for two selected interventions. During the study period, the total number of prostate biopsies declined from 184,573 to 174,558 cases. The share of outpatient biopsies declined continuously by 0.9% per year from 81% to 76% (p < 0.001). For botulinum toxin injection into the bladder, the total increased from 15,630 to 26,824cases. The share of outpatient treatments increased by 2.7% per year from 3% to 19% (p = 0.01). For the other examined interventions (insertion of suprapubic urinary catheters, the insertion, removal, and changing of ureteral stents, cystoscopies and urethral dilatation), there were no significant changes in the share of outpatient procedures. The significant increase of outpatient botulinum toxin injections shows the successful control effect through adapted remuneration options. Ashift to the inpatient sector was observed for prostate biopsies. This may be due to higher hygienic standards and technical requirements for MRI fusion.

Access and Fluoroscopy Time Difference in Patients Undergoing Prone Percutaneous Nephrolithotomy (PCNL) With Ureteric Catheter Placement in Supine Versus Lithotomy Position

Objective: To compare the operative and fluoroscopy time in two different methods of ureteral stent insertion before prone percutaneous nephrolithotomy (PCNL).Materials and method: Over 12 months, 124 patients with urolithiasis who went through prone PCNL were included in our study. All the patients had kidney stones and were divided into two groups based on the method of ureteral catheter insertion. This was done with the help of flexible or rigid cystoscopy in to group A and group B, respectively. Both groups had an equal number of patients, i.e., 62. The main outcome variables assessed were access time (from intubation to placement of access sheath) and fluoroscopy time during access.Results: The categorical variables (age, gender, site of the stone) between the two groups were comparable. The access time in groups A and B were 48±4.30 and 77±10 minutes, respectively. The fluoroscopy times in groups A and B were 52±14.63 and 116±47.77 seconds, respectively. A statistically significant difference (p-value < 0.05) was observed for both the access and fluoroscopy time. None of the patients in either of the groups had a misplaced ureteral catheter requiring repositioning.Conclusion: Flexible cystoscope-assisted insertion of ureteral catheter prior to PCNL significantly reduces operative time, fluoroscopy time, and consequently radiation exposure during PCNL.

PD32-02 POPULATION BASED STUDY ON THE INCIDENCE AND RISKS OF MULTIDRUG-RESISTANT ORGANISMS IN PATIENTS WITH URETERIC STENTS

You have accessJournal of UrologyCME1 May 2022PD32-02 POPULATION BASED STUDY ON THE INCIDENCE AND RISKS OF MULTIDRUG-RESISTANT ORGANISMS IN PATIENTS WITH URETERIC STENTS Runhan Ren, Zoe Hsu, Erik Youngson, and Shubha De Runhan RenRunhan Ren More articles by this author , Zoe HsuZoe Hsu More articles by this author , Erik YoungsonErik Youngson More articles by this author , and Shubha DeShubha De More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002583.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteric stents can lead to irritative voiding symptoms which mimic UTIs. This population is thought to be at high risk of antibiotic over-exposure. Therefore, our objective was to assess local trends in antibiotic and multidrug-resistant organism (MDRO) patterns in patients with ureteric stents. METHODS: A population level retrospective cohort of patients undergoing ureteric stent insertion was created using provincially curated inpatient, ambulatory, and primary care data, through the Data Integration, Management and Reporting unit (DIMR) in Alberta (2013-18). Those with concurrent extirpative and reconstructive surgeries were excluded. Data 1 year pre- and post-stent insertion (SI) were collected, and descriptive analyses done on demographics, cultured organisms, prescriptions, and health care utilization. MDRO were defined as urine cultures (UC) with at least 3 resistances or known resistant species. Patients with post-SI MDRO were analyzed based on pre-SI urine culture results [no growth (NG), sensitive organisms (SO), and MDRO]. RESULTS: Over the study period, 13,820 SI were completed. 78% (n=10,786) had a single stent placement. 58% were placed for stones and 18% for hydronephrosis. 7,436 UC were completed post-SI, and 35.4% were positive. Organisms with any resistance increased from 16% of all cultures pre-SI to 23.6% post-SI, with E. coli being most common. Ciprofloxacin resistance for E. coli significantly increased from 35% to 50% (p<0.05) after SI. MDRO increased from 1.2% (n=164) to 5.9% (n=815) after SI. 42% of these stents were placed for hydronephrosis and 21% for stones. 40% of these patients underwent repeat SI in the following year. 217 patients with NG and 434 with SO developed MDRO post-SI, within 2.9 and 2.7 prescriptions respectively. Patients with pre-SI MDRO were more likely to receive antibiotic prescriptions in the following year (NG 5.5 vs SO 5.7 vs MDRO 7.0) and received Ciprofloxacin 24% of time. Unplanned emergency visits were similar post-SI for the three groups (4.0 vs 4.0 vs 4.7, p=0.23), but pre-SI MDRO had significantly more emergency visits in the year prior to SI (2.6 vs 3.1 vs 4.3, p<0.0001). CONCLUSIONS: An increase in MDRO was observed after SI which was associated with an increased number of antibiotic prescriptions and increasing ciprofloxacin resistance. Unplanned emergency visits were significantly higher in patients with pre-SI MDRO, but similar post-SI. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e547 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Runhan Ren More articles by this author Zoe Hsu More articles by this author Erik Youngson More articles by this author Shubha De More articles by this author Expand All Advertisement PDF DownloadLoading ...

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

Case report of lighted ureteral stent insertion with robotic single-site radical hysterectomy in early cervical cancer treatment

Case report of lighted ureteral stent insertion with robotic single-site radical hysterectomy in early cervical cancer treatment

114 Urology Stent Recall Registry

Abstract Aim To analyse how many stent procedures were recorded (on the stent registry tool in CERNER introduced at our busy DGH) for patients undergoing an insertion of ureteric stent, this ensures patient safety is not compromised by making sure stent(s) are removed or replaced at the right time. Method Retrospective Collection of data for 3 months. Which was followed by intervention, and a further collection of data for 3 months after implementation of changes. Parameters collected included age, gender, stent recall registered, comments present in registry, removal date. Results In the first loop only 32.6% of the patient had the stent recall registered on the directory. Post Intervention (IT training, Posters, presenting half audit at clinical governance) the registry rate was 59%. The most common reason for insertion was for stone, followed by longstanding hydronephrosis. It was also interesting to note that 2 patients were found who were lost in follow up and an urgent action was taken to review them. Conclusions Cerner, which is popular in NHS trusts across UK has the feasibility of having an online stent register where the information recorded gets transferred straight to the Urology office, hence ensuring correct time of removal/ exchange of stents. Trusts across UK can develop this online registration scheme in their IT system. Developing the online registry system and encouraging this audit in all NHS trusts will significantly impact the welfare and safety of patients and reduce the economic burden of NHS in dealing with complications associated with stents.

Primary Ureteric Stent Insertion Under Local Anaesthetic or Sedoanalgesia in Non-pregnancy

Background and Objective To characterise the evidence surrounding local anaesthetic ureteric stent insertion (LAUSI) in contexts outside of pregnancy, a procedure typically performed under general anaesthetic (GAUSI), as it has never been the subject of a systematic review. Materials and Methods A systematic review of the Medline, EMBASE, PubMed, AMED, BNI, EMCARE, HMIC and PsycINFO databases was conducted to examine the published evidence in line with the Preferred Reporting Items of Systematic Review and Meta-analyses (PRISMA) guidelines surrounding the technique, patient demographics, setting, type of LA± sedoanalgesia used, cystoscopy and fluoroscopy usage, patient tolerability and pain, efficacy, complications and cost-effectiveness. Around 1,460 papers were systematically screened for inclusion. Results Seventeen studies were identified; one randomised controlled trials (RCT), four non-randomised comparative studies, and 12 case-series describing LAUSI. The 17 studies encompassed a total of some 1545 LAUSI. The clinical indications were similar to those for GAUSI. Successful LAUSI rate ranged from 71-98.9% in studies overall, with a pooled mean success rate of 89.3% overall (86.8% in LA only, 91.75% in LA ± sedoanalgesia). The tolerability of a LAUSI patient across 14 studies had a pooled mean rate of 91.8% (88.6% in LA only, 95% in LA ± sedoanalgesia). The procedure time was reported in seven studies, and it ranged from 5.35±0.87 to 65.0±27.5 minutes. The four comparative studies showed no difference in complication rates between LAUSI and GAUSI. All five studies reporting on cost-effectiveness showed LAUSI to be superior to GAUSI. Conclusions LAUSI is a safe, effective, and cost-effective alternative to GAUSI, which is under-utilised. Further research in the form of RCTs is required to formally establish its place and acceptability amongst urologists.

Does Tamsulosin use before Ureteroscopy Increase the Success of the Operation?

To investigate the effect of preoperative tamsulosin use on the success and complications rates of ureteroscopy for ureteral stone removal. A randomised clinical trial. Department of Urology, Dursun Odabas Medical Center, Van Yuzuncu Yil University, Turkey, from December 2020 to June 2021. Patients were scheduled for ureteroscopy due to ureteral stones, and were randomly divided into two groups; 67 patients preoperatively were given 0.4 mg tamsulosin for 7 days and 70 patients were not given tamsulosin. Each patient's intraoperative surgical complications, preoperative and postoperative pain, postoperative fever, need for analgesia, stone-free rate, and double J ureteral stent (DJ) insertion rates were recorded and evaluated. A total of 137 patients, 103 (75.1%) males, and 34 (24.8%) females, were included. In 70 (51.1%) of these patients, the stone was on the right side, while in 67 (48.9%) the stone was on the left side. The stone was in the distal ureter in 47 (34.3%) patients, in the middle in 38 (27.7%) patients, and the proximal in 52 (37.9%) patients. The patients who were given tamsulosin had lower preoperative visual analog scale (p=0.02), operation time (p=0.003), post-ureteroscopic lesion scale (p=0.01), postoperative 24th-hour visual analog scale (p=0.03), fever (p=0.02), and analgesic need (p=0.04), while their rate of accessing the stone (p=0.02); and their stone-free rates (p=0.02) was higher. Preoperative tamsulosin use increases the success of the operation and reduces complications. Key Words: Tamsulosin, Ureteral calculi, Ureteroscopy.

Colonic perforation during percutaneous nephrolithotomy: can we predict it

Background: Colonic perforation though rare but is one of the most dangerous complications of Percutaneous nephrolithotomy (PCNL) which may lead to increase significant post operative morbidity in worldwide, therefore, the aim of this study was to explore colonic perforation during percutaneous nephrolithotomy- Can we predict it.Methods: We reviewed retrospectively the data of 1270 PCNL procedures performed between April 2013 and April 2019 at Ayushyaman kidney hospital, Palanpur, North Gujarat, India. All parameters including demography, history, stone parameters, site of skin puncture and punctured calyx, were reviewed in all these patients.Results: Colonic perforation was found in 10 patients (7 males and 3 females) and the mean age was 40.5±20.0. The left side was affected in 4 patients and the right side was injured in 6 cases. Conservative administration was the treatment planned for all patients. It included withdrawal of the nephrostomy tube outside the kidney to the colon as a percutaneous colostomy, insertion of a double-J ureteral stent, intravenous broad-spectrum antibiotics, bowel rest and total parenteral nutrition. Under this conservative management, entire healing of the colon was achieved in all cases.Conclusions: Colonic perforation is rare complication in PCNL. High degree of suspicion, early diagnosis and timely management can prevent sepsis and peritonitis and minimize patient morbidity and mortality.

Frequency and Clinical Features of Candida Bloodstream Infection Originating in the Urinary Tract.

The urinary tract is considered an uncommon source of Candida bloodstream infection (CBSI). We aimed to determine the source of CBSI in hospitalized patients, and to compare clinical and microbiological features of CBSI originating in the urinary tract (U-CBSI) and non-urinary CBSI (NU-CBSI). Of 134 patients with CBSI, 28 (20.8%) met criteria for U-CBSI, 34 (25.3%) had vascular catheter-related CBSI and 21 (15.6%) had a gastrointestinal origin. Compared to NU-CBSI patients, patients with U-CBSI were older with higher rates of dementia. Bladder catheterization for urinary retention and insertion of ureteral stents or nephrostomies were risk factors for U-CBSI. Fifty percent of U-CBSI cases occurred within 48 h of hospital admission, versus 16.9% of NU-CBSI (p < 0.0001). The mortality rate was lowest for CBSI originating in the urinary tract and highest for CBSI of undetermined origin. CBSI of undetermined origin remained associated with higher mortality in a Cox regression model that included age, Candida species, Pitt bacteremia score and neutropenia as explanatory variables. U-CBSI may be increasing in frequency, reflecting extensive use of bladder catheters and urologic procedures in elderly debilitated patients. Distinct clinical features are relevant to the diagnosis, treatment and prevention of U-CBSI.

Urine Bacteriology in Post-Kidney Transplant Patients with Double-J Stents

Background: Kidney transplantation is the gold standard treatment modality for patients with end-stage renal disease. Ureteric stenting is commonly used during kidney transplantation to reduce the incidence of ureteric complications post-transplantation. The presence of ureteric stents could be complicated by bacterial colonisation and urinary tract infections.&#x0D; Objective: To identify the urinary flora in patients with double-J stents following kidney transplantation and establish bacteria colonisation and their antimicrobial susceptibility.&#x0D; Methods: Over one-year, single urine samples of consecutive 100 post-renal transplant patients were subjected to bacteriologic analysis. Early morning midstream urine was obtained into a sterile bottle from all the participants for laboratory analysis.&#x0D; Results: The mean age of post kidney transplantation patients was 47.6 ±12.3 years. Hypertension and diabetes were the commonest co-morbidities associated with End-Stage-Renal-Disease (ESRD), accounting for 61% and 28%, respectively. E. coli was the commonest isolate (70.4%). Microbiological evidence of Urinary Tract Infection (UTI) revealed by pyuria (pus cells &gt;4/HPF) was found in 40.9%. Tigecycline, nitrofurantoin and tetracycline showed the highest sensitivity pattern in 9%, 8% and 8%, respectively, with significant resistance against cephalosporins and fluoroquinolones.&#x0D; Conclusion: The fourth week of double-J ureteric stent insertion in kidney transplant recipients showed a high incidence of urinary bacterial colonisation.

Innovation and new technology in ureteral stents

Ureteral stent insertion is a procedure performed extensively by all urologists. Nevertheless, stent-related symptoms and stent encrustation are still common complications pushing the innovation and development of novel ureteral stents. Developments are focussing on three significant aspects: material, design, and removal technique. Various materials including silicone, polymers, and metals are frequently utilized, with or without an additional coating. The use of biodegradable materials is looking promising but these is a lack of proven clinical trials in association with this in humans. The new designs focus on the reduction of stent-related symptoms through the modification of the bladder end. The new stent removal techniques with extraction strings or novel magnetic end may exclude subsequent cystoscopic procedures. Finally, utilization of a ureteral stent tracker application helps in reminding both physicians and patients to remove the stent at the appropriate time.

Early diagnosis and management of maternal ureterohydronephrosis during pregnancy.

Maternal ureterohydronephrosis (UHN) is a common anatomical change during the evolution of pregnancy, diagnosed especially after the 20th week of pregnancy. The aim of the present study was to evaluate the stages of UHN during pregnancy, depending on the gestational age, and to monitor the symptomatology and the adequate management. A total of 58 pregnant women with UHN, hospitalized in the Constanta County Emergency Hospital, were included in the present study, and had nephrological monitoring using ultrasound examination. Right UHN was observed in all cases and left UHN was observed in only 67.24% of the cases. Regarding the gestational age, right UHN grade III was most commonly seen between 27 and 31 weeks of pregnancy (48.6% of total right UHN grade III from the studied group). The data showed that gestational age and grade of UHN had a highly dependent association in the studied group. The majority of our patients (67.24%) were symptomatic, and the most common complaint on presentation was lumbar pain. According to the visual analog scale (VAS) of the lumbar pain, the group could be distributed as follows: 17.24% with severe pain, 36.21% with moderate pain and 13.79% with mild pain. Eight pregnant women (13.79%) from the present study developed UHN due to passage of a ureteral stone, although the majority of the patients experienced complications with urinary tract infection and acute kidney injury. In addition, 97% of the symptomatic UHN responded to conservatory treatment and only 2 patients (3.45%) with severe symptomatic UHN needed ureteral stent insertion. Data analysis was performed using IBM SPSS Statistics 23. The study highlighted the existence of an association between gestational age and UHN grading.

Successful treatment with radiation therapy for desmoid-type\xa0fibromatosis\xa0with unilateral hydronephrosis: a case report

BackgroundDesmoid-type fibromatosis is a rare disease that can result in hydronephrosis. Hydronephrosis associated with desmoid-type fibromatosis often requires surgery or ureteral stent insertion. Although radiation therapy is recommended for inoperable cases of desmoid-type fibromatosis, there has been no report of treatment for hydronephrosis associated with desmoid-type fibromatosis by radiation therapy alone. We herein report a case of successful treatment for inoperable recurrence of desmoid-type fibromatosis with unilateral hydronephrosis by radiation therapy alone.Case presentationA 43-year-old Japanese female underwent resection of desmoid-type fibromatosis in the right inguinal region and combined resection of the right external iliac vein 5 years before. Other treatment was not performed because of her pregnancy. Four years after surgery, desmoid-type fibromatosis recurred in the right pelvic wall. Cyclooxygenase-2 selective inhibitor treatment was given for 1 year, but her desmoid-type fibromatosis enlarged to more than 10 cm, and she had swelling of her right leg and hydronephrosis of her right kidney. The patient received 50.4 Gy in 28 fractions of prophylactic irradiation using 10 MV X-ray and 9 Gy in five fractions of a sequential boost for the recurrent desmoid-type fibromatosis. Although there was temporary tumor progression at 1 month after radiation therapy, slow regression of the tumor was seen. At 5 years after radiation therapy, there was no disease progression or severe complications.ConclusionWe experienced successful treatment for an inoperable case of desmoid-type fibromatosis with hydronephrosis. Moderate-dose radiation therapy alone is an effective and feasible approach for the management of hydronephrosis associated with desmoid-type fibromatosis.

Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy

BackgroundTo assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy.MethodsWe performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee.ResultsThe pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up.ConclusionsThe current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.

Low Body Mass Index as a Predictive Factor for Postoperative Infectious Complications after Ureterorenoscopic Lithotripsy

Background and Objectives: In this study, we aimed to evaluate predictive factors of postoperative fever (POF) after ureterorenoscopic lithotripsy (URSL). Materials and Methods: A total of 594 consecutive patients who underwent URSL for urinary stone disease at Gifu Municipal Hospital and Chuno Kosei Hospital between April 2016 and January 2021 were enrolled in this study. In all patients, antibiotics were routinely administered intraoperatively and the next day after surgery. We used rigid and/or flexible ureterorenoscopes depending on the stone location for URSL. Stones were fragmented using a holmium: YAG laser. The fragments of the stone were manually removed as much as possible using a stone basket catheter. A ureteral stent was placed at the end of the surgery in all cases. Results: The median age and body mass index (BMI) in all patients were 62 years and 23.8 kg/m2, respectively. The median operation duration was 52 min. The most common URSL-related complication was POF in 28 (4.7%) patients. In these patients, the rates of antibiotic administration and ureteral stent insertion before surgery were significantly higher than in those without POF. In multivariate analysis, BMI was associated with POF after URSL. There were no significant differences in predicting POF after surgery in patients who had bacteriuria or received antibiotics before surgery. Conclusions: A low BMI was significantly associated with POF after URS or URSL.

187 A Rare Case of Colovesical Fistula in A Patient with Situs Inversus

Abstract A 47 year old man with no past medical history presented to the urology clinic with recurrent urinary tract infections caused by E.Coli. He subsequently had a number of investigations including imaging and cystoscopy which showed a high possibility for a colovesical fistula and incidentally demonstrated subdiaphragmatic Situs inversus. The sigmoid colon was inflamed and adherent to the posterior wall of the bladder. Surgical management following a multi-disciplinary decision resulted in an elective Ureteric stent insertion followed by laparotomy with sigmoid colectomy and primary anastomosis. The bladder wall defect caused by fistula formation was repaired. We report an extremely rare case of colovesical fistula in the setting of subdiaphragmatic situs inversus in a relatively young patient. This would likely be seen in older patients with more severe diverticulitis and usually in an acute setting. Anatomical variation resulted in more severe diverticular disease and predisposed to fistula formation.