PAEA Surgery End Of Rotation (EOR) Practice Exam

What is the treatment for a colovesical fistula?

1. Colectomy and primary bladder closure

2. Antibiotic therapy and observation

3. Colonoscopy and cauterization

4. Urinary diversion and stenting

The correct answer is: Colectomy and primary bladder closure

The treatment for a colovesical fistula, which is an abnormal connection between the colon and the bladder often caused by diverticulitis or malignancy, typically involves surgical intervention. The correct approach, which is indicated here, includes a colectomy to remove the diseased segment of the colon and primary closure of the bladder to effectively repair the defect. This method addresses both the underlying cause of the fistula and the restoration of the anatomical integrity of both the bowel and the urinary system. Surgical management is essential because simply observing or using conservative management strategies, such as antibiotic therapy, may not resolve the fistula and can lead to ongoing urinary complications, infections, or further deterioration of the patient’s condition. Less invasive techniques, like colonoscopy and cauterization, are generally not effective for fistula treatment because they do not adequately address the structural and functional abnormalities of the involved organs. Similarly, urinary diversion and stenting may provide temporary relief for urinary issues but do not resolve the fistula itself and delay necessary definitive treatment.