colovesical

Colovesical is an anatomical and clinical term describing a relationship between the colon and the urinary bladder. It most often refers to a colovesical fistula, an abnormal communication between the sigmoid colon and the bladder that allows contents from the colon to enter the urinary tract and may permit gas to pass into urine.

Etymology stems from colon and vesical (relating to the bladder). The leading cause in adults is diverticular disease with chronic inflammation that promotes fistula formation. Other causes include Crohn's disease, colorectal cancer, pelvic radiation, trauma, and postoperative complications.

Colovesical fistulas arise when inflammatory or neoplastic processes erode the walls of the colon and bladder, creating a tract between them. This can lead to symptoms such as pneumaturia (air in urine) and fecaluria (feces in urine), along with recurrent urinary tract infections and lower abdominal or pelvic pain. Some patients may have irritative urinary symptoms without fecaluria.

Diagnosis typically involves imaging and endoscopic evaluation. CT urography or CT enterography with contrast is commonly used to visualize the fistula and its underlying cause. Cystoscopy and colonoscopy can help localize the fistula and assess mucosal disease. Additional studies may be needed based on clinical suspicion.

Management targets the underlying disease and fistula closure. Most cases related to diverticular disease require surgical resection of the diseased colon with repair of the bladder, sometimes with urinary diversion or a staged approach. Perioperative antibiotic therapy is standard.

Prognosis is generally favorable with appropriate surgical treatment, though complications such as incomplete fistula closure or recurrent infection can occur.