EP520 - Early Foley Removal Without Cystogram After Colovesical Fistula Surgery: Safe in Patients Without Bladder Repair

Purpose/Background: Colovesical fistulas (CVF), most commonly from complicated diverticulitis, are typically managed surgically. Postoperative bladder management practices vary widely. Traditionally, foley catheters are left for 7-14 days and removed only after a negative cystogram. Emerging data suggest early catheter removal without cystogram may be safe. We hypothesized that early foley catheter removal without cystogram is safe in patients undergoing no bladder repair.

Methods/Interventions: We performed a retrospective chart review of patients undergoing definitive operative management of CVF across one health care system (2020-2025). Demographics, comorbidities, surgical approach, bladder repair type, foley catheter duration, cystogram, and outcomes were analyzed. Bladder repair was done by surgeon discretion and categorized as none, simple, or complex. Statistical comparisons were performed using Chi-square, Fisher's exact, and non-parametric tests, with p < 0.05 significant.

Results/Outcomes: Twenty-three patients met inclusion criteria (mean age 65 ± 11.9 years; 61% male). Etiologies included diverticulitis (87%), malignancy (4%), and inflammatory bowel disease (9%). Surgical approach was open (28%), laparoscopic (22%), hand-assisted (13%), and robotic-assisted (30%). Bladder management included no repair (48%), simple repair (22%), and complex repair (30%). All patients had an intra-operative leak test that was negative. Foley duration differed significantly across groups: no repair 3 ± 4 days vs repair 14±7 days, (p < 0.001). Robotic surgery was associated with shorter foley duration compared with open and laparoscopic approaches (p = 0.007). Open surgery had the longest length of stay (14±9 days) irrespective of any bladder repair (p=0.01). Cystography prior to catheter removal was performed in 92% of patients with repair vs 27% without repair; all were negative for leak. 67% of the repair group was discharged with a foley catheter that was subsequently removed after cystogram at 16 ± 4 days.

Overall, 32% experienced complications and 24% were readmitted. Complications occurred in 58% of the repair group and 67% of complex repairs, including GI bleed, AKI and DVT. No repair was associated with a significantly lower complication rate (p=0.024). UTI occurred in 8% of patients with no repair vs 41% with repair (trend, p = 0.099). Long-term outcomes included one vesicovaginal fistula and one case of persistent urinary incontinence after complex repair.

Conclusion/Discussion: Early foley catheter removal without cystogram after CVF surgery appears safe when no bladder repair is required. Routine prolonged catheterization and postoperative cystography may not be indicated in these patients.

Foley Catheter duration
The above graph indicates the foley catheter duration in days based on surgery type (open, had assisted, robotic and laparoscopic) and type of bladder repair of colovesical fistula.