Could I get a Doctor's opinion in regards to a fistula

[rmprdl1964]

Hi, I have tried to get some information in regards to the possible need of a colostomy.
I'm 44 and was diagnosed as having a prostate to rectum fistula. I have had a catheter in sinse March.
I was seen by a urologist and had 2 cystoscopies done with a 6 week period in between to see if spontaneous healing would take place. So far it has not and I was referred to a reconstructive urologist. The original urologist advised me that a possible colostomy would be considered. Would it not be more practicle to repair the fistula instead of diversion?
If no healing by having a catheter in sinse about March has taken place, I doubt that healing would take place when the bowel is deverted by a colostmy.
Your opinion would be appreciated.

Thank you.

[rmprdl1964]

Dear Dr. Liroff,

I have a follow up appointment with the urologist on January 6 2009. He felt that the fistula has improved. However this is the first time that he had performed a cystoscopy on me.
I'm also experiencing more discomfort and still occasionally notice stool in my urine as well as the passing of gas through the penis.
A few days after the last cystoscopy, I noticed having passed some blood clots. Could it be that this seemed like the fistula was closing?
Your opinion is greatly appreciated.

Sincerely,

Ron

[rmprdl1964]

Dear Dr. Liroff,

Thank you for your insight. I recently had another cystoscopy done by a reconstructive urologist. He stated that he wanted the catheter in for another 6 weeks and then review tings again.
I still experience bouts of getting stool in my drainage bag as well as passing gas through the catheter or in between the penis and catheter. I now also expereince a lot of discomfort in the area between the penis and rectum at times.
As you have stated that this rarely heals on its own, I very much doubt that it will close without intervention.
I have had  this indwelling catheters in since March 2008.
I guess I will see what happens when I go in for review on January 8, 2009.
I'm just frustrated by the fact that I have been waiting this long, and still not know what will be done to repair this fistula.

Thank you,

Ron

[Stephen Liroff, MD]

Most fistulas are between bladder and colon. Usually related to diverticulitis (infected outpouching from large intestine). Prostatic/rectal fistulas are quite rare. Colovesical fistulas seldom heal on their own. They may open and close but, again, persist. They do require surgery - usually removal of the diseased portion of bowel and possibly a small portion of bladder.
You'll probably need a pelvic CAT scan and possibly a barium enema to demonstrate radiologically what is happening and help, thereby, to plan the surgery (in addition to the cysto).
Good luck!
S.A.Liroff, M.D.

[rmprdl1964]

Dear Dr. Liroff,


Thank you for your reply.

The urologist regarding my case is planning to do another cystoscopy. I would guess that this is done to find out where the fistula is located.
As for the cause, I'm not sure as to why this happned. I have a neurogenic bladder and used to self cath as required. It was during my hospital stay in March this year for a kidney infection and pneumonia that I noticed that I was passing gass past the catheter.

I have not had recent surgeries on the pelvic region other than a hernia repair on the right site in 2006.

My concern is that I have had this catheter in March, but the catheter was changed in April and July. If there was to be any healing, should it not have occured by now?

Sincerely,

Ronald

[Stephen Liroff, MD]

First, why the fistula? Radiation?, trauma? Cancer? Often the colostomy is done at the time of fistula repair to protect the fistula during healing. Only if the urologist does not feel that the fistula can be cured would I expect  a diversion alone. Ask the urologist lots of questions, keep up the dialogue!
S.A.Liroff, M.D.