The staged management of complex entero-urinary fistulae

Objective To present the results of the staged management of complex entero -urinary fistulae. Patients and methods Ten patients with complex entero-urinary fistulae were reviewed; all patients were referred to a national intestinal failure unit after failed treatment in other centres. Each patient was treated in three stages. The acute stage involved proximal defunctioning and distal drainag e of both the gastrointestinal and urinary tracts to isolate the fistula, t ogether with the eradication of sepsis. The recovery stage involved total p arenteral nutrition, organ support, radiological planning of surgical recon struction and intensive nursing. The reconstructive stage followed when the patient was stable, nutritionally replenished and intra-abdominal sepsis w as controlled. Surgery was undertaken jointly by urological and gastrointes tinal surgeons. Results The fistulae were treated successfully in all patients, with functi onal restoration in four, and/or diversion of the gastrointestinal and urol ogical tracts in six. The mean (range) time to reconstruction was 5 (1-20) months. There were no postoperative deaths. Conclusion A staged multidisciplinary approach with delayed reconstruction can achieve a successful outcome in the management of complex entero-urinar y fistulae.