Fistula Repair (All Patients)
This atlas groups upper-tract, bowel–bladder, cutaneous, transplant and arterial fistulas. Start with source control, organ function, viable tissue and the patient's ability to tolerate reconstruction. Closure of the fistula, preservation of kidney function and freedom from later obstruction are different outcomes. The database links to technique-specific evidence and limitations.
Decision Framework
| Fistula | Initial priorities | Reconstruction considerations |
|---|---|---|
| Pyeloenteric | Control infection and ensure renal drainage; assess salvageable function | Treat renal and bowel disease; kidney-preserving repair or nephrectomy depends on function, tissue and cause |
| Nephropleural | Decompress the urinary source and manage the pleural collection | Escalate pleural treatment for inadequate drainage, infection or organization; pleural procedures alone do not correct the urinary source |
| Ureterocolonic | Define ureteral injury/obstruction and bowel pathology; drain infection | Bowel resection and ureteral repair are selected separately; neither automatic nephrectomy nor leaving every ureter unrepaired is appropriate |
| Colovesical / enterovesical | Identify diverticular, Crohn's, malignant or other cause | Resect diseased bowel when indicated; bladder closure and one-stage versus staged bowel reconstruction depend on the defect and setting |
| Vesicocutaneous | Evaluate obstruction, bladder pressure, infection and tissue viability | Selected leaks may close with drainage; persistent or unhealthy defects may need repair and vascularized coverage |
| Post-transplant | Early low-volume leaks may respond to drainage; massive leaks or nonviable ureter need surgical assessment | Repeat implantation, native ureter or bladder-based reconstruction according to viable tissue and reach |
| Ureteroarterial | Potential hemorrhagic emergency: coordinate vascular surgery, interventional radiology and urology | Endovascular control is commonly favored initially; infection, anatomy, recurrence and available expertise may require open or staged treatment |
Historical upper-tract diversion studies combine different fistula sites and causes. Their closure percentages cannot be assigned to every pyeloenteric or ureterocolonic case.[1] Likewise, pleural drainage alone may fail when the urinary source remains uncontrolled.[2]
For diverticulitis complicated by fistula, ASCRS recommends consideration of elective colectomy; the extent and timing are individualized. Crohn's medical therapy requires assessment and control of abscess/sepsis, and perianal-fistula drug trials should not be treated as ureterocolonic repair evidence.[3][4] The transplant and arterial pathways have distinct urgent-care requirements.[5][6]
Treatment Database
| Technique | Fistula Type | Selection considerations |
|---|---|---|
| Pyeloenteric Fistula Repair | Pyeloenteric | Renal drainage, bowel treatment and kidney salvage selected by cause and residual function. |
| Nephropleural Fistula Repair | Nephropleural | Urinary-source decompression plus pleural management tailored to the collection. |
| Ureterocolonic Fistula Repair | Ureterocolonic | Assess bowel disease and ureteral viability separately; drainage, bowel resection and reconstruction as indicated. |
| Colovesical / Enterovesical Fistula Repair | Colovesical / Enterovesical | Bowel and bladder management selected by cause, defect and fitness for surgery. |
| Vesicocutaneous Fistula Repair | Vesicocutaneous | Drainage and correction of bladder/obstructive causes; repair or tissue coverage when needed. |
| Post-Kidney-Transplant Ureteral Fistula Repair | Post-Transplant | Drainage for selected small leaks; reconstruction for massive, persistent or ischemic defects. |
| Ureteroarterial Fistula Repair | Ureteroarterial | Urgent multidisciplinary hemorrhage control; endovascular, open or staged treatment by anatomy and infection. |
| Fecal Diversion | Colovesical / Enterovesical | Selected adjunct for contamination control or protection of a complex bowel repair. |
References
1. Maillet PJ, Pelle-Francoz D, Leriche A, Leclercq R, Demiaux C. Fistulas of the upper urinary tract: percutaneous management. J Urol. 1987;138(6):1382–5. doi:10.1016/s0022-5347(17)43648-2
2. Toubes ME, Lama A, Ferreiro L, et al. Urinothorax: a systematic review. J Thorac Dis. 2017;9:1209–1218. doi:10.21037/jtd.2017.04.22.
3. Hall J, Hardiman K, Lee S, et al. ASCRS clinical practice guidelines for treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020;63:728–747. doi:10.1097/DCR.0000000000001679.
4. Lightner AL, Vogel JD, Carmichael JC, et al. ASCRS clinical practice guidelines for surgical management of Crohn's disease. Dis Colon Rectum. 2020;63:1028–1052. doi:10.1097/DCR.0000000000001716.
5. European Association of Urology. EAU Guidelines on Renal Transplantation. 2026. Section 3.1.7.h, urinary leak. Guideline.
6. Kamphorst K, Lock TMTW, van den Bergh RCN, et al. Arterio-ureteral fistula: systematic review of 445 patients. J Urol. 2022;207:35–43. doi:10.1097/JU.0000000000002241.