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Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae

  • Urology - Original Paper
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Abstract

Purpose

The objective of this study was to assess the accuracy of cystoscopy and cystography, as compared to other diagnostic studies, in identifying vesicoenteric fistulae (VEF) in a contemporary series of patients with surgically confirmed VEF.

Methods

With institutional review board approval, we performed a single-center retrospective review of surgically confirmed VEF between 2002 and 2018. Demographic data, comorbidities, symptoms, and diagnostic evaluation were reviewed. The sensitivity, specificity, and accuracy of cystoscopy in diagnosis of VEF were compared to cross-sectional imaging.

Results

The study cohort consisted of 51 patients with surgically confirmed VEF secondary to diverticular disease. Diagnostic evaluation included cross-sectional imaging with CT (94%), colonoscopy (82%), cystoscopy (75%), cystography (53%), and barium enema (26%). Cystoscopic evaluation definitively demonstrated evidence of VEF in 34% of patients, while 55% of patients had nonspecific urothelial changes on cystoscopy without definitively demonstrating VEF. Comparatively, the sensitivity of VEF was 25% for cystography and 84% for CT.

Conclusions

In clinical practice, the diagnostic work-up of VEF is variable. In the modern era of managed care, inclusion of cystoscopy and cystography in the evaluation of VEF does not contribute a substantial additive benefit over standard cross-sectional imaging. Cystoscopy and cystography could potentially be eliminated from the diagnostic evaluation of VEF, in the absence of a concern for malignancy, in an effort to minimize unnecessary invasive testing as well as health care expenditures.

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Acknowledgements

All authors have read and approved the manuscript. The manuscript is not under consideration elsewhere.

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Authors and Affiliations

  1. Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA

    Florian A. Stroie, Osamah M. Hasan, Matthew D. Houlihan, Brian J. McArdle, Courtney M. P. Hollowell, Patricia P. Vidal & Sarah P. Psutka

  2. Midwestern University Chicago College of Medicine, 555 31st Street, Downers Grove, IL, USA

    Osamah M. Hasan

  3. Division of Colorectal Surgery, Department of Surgery, Cook County Health and Hospitals System, Chicago, IL, USA

    Jennifer Blumetti

  4. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sarah P. Psutka

Authors
  1. Florian A. Stroie
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  2. Osamah M. Hasan
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  3. Matthew D. Houlihan
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  4. Brian J. McArdle
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  5. Courtney M. P. Hollowell
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  6. Jennifer Blumetti
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  7. Patricia P. Vidal
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  8. Sarah P. Psutka
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Contributions

FAS: data collection, manuscript writing. OMH: manuscript writing. MDH: manuscript writing. BJM: data analysis. CMPH: manuscript editing. JB: procedure data/analysis. PPV: protocol management. SPP: protocol development/data management.

Corresponding author

Correspondence to Osamah M. Hasan.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

None.

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Not obtained, due to the retrospective character of the study.

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Stroie, F.A., Hasan, O.M., Houlihan, M.D. et al. Low diagnostic sensitivity of cystoscopy and cystography of surgically confirmed vesicoenteric fistulae. Int Urol Nephrol 52, 1203–1208 (2020). https://doi.org/10.1007/s11255-020-02409-x

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  • DOI: https://doi.org/10.1007/s11255-020-02409-x

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