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Ureterocolonic Fistula — Management

A rare uroenteric fistula most commonly caused by diverticular disease, Crohn's disease, or malignancy. Surgical resection of the diseased bowel segment with primary anastomosis is the standard treatment; manipulation of the urinary tract is generally unnecessary unless the kidney is non-functioning.[1] See clinical page: Ureterocolonic Fistula.

Surgical Resection​

Diseased bowel segment resected with primary anastomosis; the involved ureter is usually preserved unless devascularized or injured beyond repair. If the kidney is non-functioning, ipsilateral nephrectomy may be required.[1]

Crohn's Disease — Medical Therapy​

Anti-TNF therapy (infliximab, adalimumab) may induce fistula remission in a selected subgroup (~45% sustained remission without surgery), though > 80% of patients ultimately require surgery, which achieves sustained remission in 99%.[2]

The 2025 ACG guidelines recommend infliximab with or without an immunomodulator as initial therapy before surgery for fistulizing Crohn's disease.[3] The AGA guidelines conditionally recommend infliximab or adalimumab (with or without a thiopurine) for induction of fistula remission, and note that combining a TNF-α antagonist with ciprofloxacin for 12 weeks is significantly more effective than biologic monotherapy.[4]

References​

1. Cirocco WC, Priolo SR, Golub RW. Spontaneous ureterocolic fistula: a rare complication of colonic diverticular disease. Am Surg. 1994;60(11):832–5.

2. Taxonera C, Barreiro-de-Acosta M, Bastida G, et al. Outcomes of medical and surgical therapy for entero-urinary fistulas in Crohn's disease. J Crohns Colitis. 2016;10(6):657–62. doi:10.1093/ecco-jcc/jjw016

3. Lichtenstein GR, Loftus EV, Afzali A, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2025;120(6):1225–1264. doi:10.14309/ajg.0000000000003465

4. Feuerstein JD, Ho EY, Shmidt E, et al. AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease. Gastroenterology. 2021;160(7):2496–2508. doi:10.1053/j.gastro.2021.04.022