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Ureterocolonic Fistula Repair

Treat the bowel pathology and urinary tract together, with attention to kidney salvage, ureteral viability and sepsis. Resection of diseased colon may be necessary, but does not guarantee that an injured or obstructed ureter will heal without repair. See Ureterocolonic Fistula for presentation and diagnostic workup.

Initial Management​

Define the tract, associated abscess, obstruction, renal function and any malignant or inflammatory cause. Coordinate urology, colorectal surgery and interventional radiology. Control sepsis with antibiotics and drainage, relieve clinically significant urinary obstruction and address nutrition. Ureteral stenting or nephrostomy can provide diversion; a bowel stoma is a selected adjunct rather than mandatory treatment for every fistula.[2][3]

For an iatrogenic injury, prompt treatment is important. When repair is feasible, timing depends on tissue, physiological stability and expertise; selected incomplete injuries can be managed with retrograde or antegrade stenting. Complete disruption, a long devitalized segment or failed drainage may require reconstruction. There is no general requirement to wait for a fixed interval while leakage or infection continues.[10]

When Drainage May Be Definitive​

Evidence specific to ureterocolonic fistulas is mostly case reports, not comparative trials:

  • Lang's 15-patient experience combined ureteroenteric, cutaneous, vaginal and retroperitoneal fistulas. It supports feasibility of nephrostomy with antegrade stenting, not a ureterocolonic-specific closure probability.[1]
  • Krishna described an 88-year-old whose diverticular fistula closed after proximal colostomy; closure was documented when she returned for planned sigmoid colectomy. This single case does not establish that fecal diversion alone definitively treats the underlying diverticular disease.[4]
  • Tramontano's 2025 postoperative ureterocolic fistula resolved after an endoscopic/percutaneous approach. It illustrates a selected successful pathway rather than superiority over reconstruction.[5]

Document closure and unobstructed drainage before ending treatment, and monitor for later ureteral stenosis. Drainage-device exchanges and removal require an explicit follow-up plan.[2][10]

Selecting an Operation​

Bowel Resection and Ureteral Assessment​

For fistulizing diverticulitis, ASCRS 2020 recommends elective colectomy when appropriate. Primary anastomosis, protected anastomosis or staged reconstruction depends on contamination, inflammation, tissue and patient condition.[15]

Cirocco's 1994 report reviewed only five reported diverticular ureterocolic cases. Favorable results after bowel-directed surgery and its advice to avoid unnecessary urinary dissection should not be generalized to an ischemic ureter, a complete iatrogenic disruption or malignant involvement. Assess ureteral patency and viability directly when deciding whether it needs repair.[6][10]

Remove the diseased bowel segment when indicated and preserve uninvolved tissue where possible. Separate adjacent repairs with healthy tissue when feasible; the rarity of this fistula precludes a reliable estimate of the independent benefit of omental interposition.[10][14]

Ureteral Reconstruction When the Kidney Is Salvageable​

The following applies established ureteral-injury principles; published general reconstruction results are not ureterocolonic-fistula success rates.[10]

AnatomyPotential reconstruction
Distal defect with adequate reachUreteroneocystostomy
Distal defect with insufficient reachBladder mobilization/psoas hitch or Boari flap if bladder tissue and function permit
Short mid/proximal defect with viable endsUreteroureterostomy
Extensive loss not amenable to standard repairSelected transureteroureterostomy, bowel substitution or renal autotransplantation in an experienced center

Preserve periureteral blood supply, debride devitalized tissue and obtain a spatulated, watertight anastomosis without tension. Provide appropriate internal stenting and drainage. Defect length alone does not establish bladder reach; prior radiation, bladder capacity and tissue quality matter. Transureteroureterostomy exposes the opposite urinary tract to risk, and bowel substitution may be unsuitable in active bowel disease or limited bowel reserve.[10]

See Ureteral Reimplantation, Boari Flap & Psoas Hitch and Ureteroureterostomy.

Nephrectomy / Nephroureterectomy​

Removal may be appropriate for a chronically infected, nonfunctional or otherwise unsalvageable renal unit; the extent of ureteral removal depends on the cause and involved tissue. Assess contralateral function and reversible obstruction rather than treating any low differential function as an automatic indication. Pediatric iatrogenic, diverticular and stone/XGP reports illustrate selected nephroureterectomies, not a validated renal-function threshold for every patient.[7][8][9]

Crohn's Disease: Keep the Evidence in Context​

Identify and control abscess/sepsis before escalating immunosuppression. ASCRS recommends considering surgery for enteric fistulas that persist despite appropriate medical therapy; uncontrolled penetrating complications also favor resection. Diseased bowel and a secondarily involved urinary organ may need different treatment.[14]

The AGA biologic-plus-antibiotic recommendation concerns active perianal fistulas without perianal abscess. It does not establish a standard 12-week ciprofloxacin regimen for ureterocolonic fistula. Medical therapy for internal urinary fistulas should be selected with the IBD team and reassessed against infection, obstruction and kidney function.[13][14]

Original studyRelevant finding and limitation
Taxonera, 2016Among 97 entero-urinary fistula patients, 33 received anti-TNF and 45% of those 33 achieved sustained remission without surgery. More than 80% of the full cohort underwent surgery; 99% of surgical patients achieved remission. Retrospective selection and mixed anatomy limit comparisons[12]
Chen, 2023All 74 patients underwent surgery. After preoperative optimization, 42 had no urinary-fistula symptoms; bladder repair was needed in 9/42 versus 19/32 with persistent symptoms. This is symptom improvement before surgery, not a 57% nonsurgical closure rate. Three recurrent bladder fistulas occurred[11]

These studies predominantly inform broader entero-urinary/bladder disease, not a proven ureterocolonic-specific drug or repair success rate.

Endoscopic and Other Limited-Evidence Options​

Clips, suturing or sealants may be considered by an experienced multidisciplinary team for selected defects, usually after source control and assessment of surrounding tissue. General GI leak literature does not establish which device reliably closes a ureterocolonic fistula.[17][18]

Sharma's fibrin-glue report included eight urinary pathologies, one of which was a caliceal diverticulum and seven fistulas of different sites, including one ureterorectal tract. Six of eight succeeded overall; that 75% is not a ureterocolonic closure rate. Repeated procedures and eventual operative salvage may be necessary.[16]

Counseling and Follow-Up​

Discuss the possibility of persistent fistula, urinary infection, ureteral stricture, bowel-anastomotic complications, diversion and renal loss. Confirm both urinary and bowel recovery; absence of external leakage alone does not prove unobstructed drainage. A successful small series cannot supply an individual 91–100% guarantee.[2][10]

References​

1. Lang EK. "Diagnosis and management of ureteral fistulas by percutaneous nephrostomy and antegrade stent catheter." Radiology. 1981;138(2):311–317. doi:10.1148/radiology.138.2.7455109

2. Hausegger KA, Portugaller HR. "Percutaneous nephrostomy and antegrade ureteral stenting: technique–indications–complications." Eur Radiol. 2006;16(9):2016–2030. doi:10.1007/s00330-005-0136-7

3. Gill HS. "Diagnosis and surgical management of uroenteric fistula." Surg Clin North Am. 2016;96(3):583–592. doi:10.1016/j.suc.2016.02.012

4. Krishna AV, Dhar N, Pletman RJ, Hernandez I. "Spontaneous closure of ureterocolic fistula secondary to diverticulitis." J Urol. 1977;118(3):476–477. doi:10.1016/s0022-5347(17)58070-2

5. Tramontano S, Iacone B, Parrella V, et al. "Case report: unusual presentation and atypical course of a case of ureterocolic fistula after anterior resection for sigmoid cancer." Front Oncol. 2025;15:1549485. doi:10.3389/fonc.2025.1549485

6. Cirocco WC, Priolo SR, Golub RW. "Spontaneous ureterocolic fistula: a rare complication of colonic diverticular disease." Am Surg. 1994;60(11):832–835. PubMed.

7. Omar H, Fulaij AA, Felemban J, et al. "Iatrogenic ureterocolic fistula in pediatric age group: a case report and review of the literature." Urology. 2023;173:e1–e5. doi:10.1016/j.urology.2023.01.005

8. Maeda Y, Nakashima S, Misaki T. "Ureterocolic fistula secondary to colonic diverticulitis." Int J Urol. 1998;5(6):610–612. doi:10.1111/j.1442-2042.1998.tb00422.x

9. Flood HD, Jones B, Grainger R. "Ureterocolic fistula: a unique complication of extracorporeal shock wave lithotripsy." J Urol. 1992;147(1):122–124. doi:10.1016/s0022-5347(17)37154-9

10. de'Angelis N, Schena CA, Marchegiani F, et al. "2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery." World J Emerg Surg. 2023;18(1):45. doi:10.1186/s13017-023-00513-8

11. Chen Y, Cao L, Qiu J, et al. "Surgical management and outcome of entero-urinary fistula complicating Crohn's disease: a single center study." World J Surg. 2023;47(12):3365–3372. doi:10.1007/s00268-023-07196-x

12. 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):657–662. doi:10.1093/ecco-jcc/jjw016

13. 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 AGA recommendations.

14. Lightner AL, Vogel JD, Carmichael JC, et al. "The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of Crohn's disease." Dis Colon Rectum. 2020;63(8):1028–1052. doi:10.1097/DCR.0000000000001716

15. Hall J, Hardiman K, Lee S, et al. "The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis." Dis Colon Rectum. 2020;63(6):728–747. doi:10.1097/DCR.0000000000001679

16. Sharma SK, Perry KT, Turk TM. "Endoscopic injection of fibrin glue for the treatment of urinary-tract pathology." J Endourol. 2005;19(3):419–423. doi:10.1089/end.2005.19.419

17. Willingham FF, Buscaglia JM. "Endoscopic management of gastrointestinal leaks and fistulae." Clin Gastroenterol Hepatol. 2015;13(10):1714–1721. doi:10.1016/j.cgh.2015.02.010

18. Cereatti F, Grassia R, Drago A, Conti CB, Donatelli G. "Endoscopic management of gastrointestinal leaks and fistulae: what option do we have?" World J Gastroenterol. 2020;26(29):4198–4217. doi:10.3748/wjg.v26.i29.4198