Editing Functional: Urinary Fistulae (section)

==== Management ====
* '''<span style="color:#ff0000">Nonoperative management</span>'''
** '''<span style="color:#ff0000">Option in selected nontoxic, minimally symptomatic patients with nonmalignant causes with vesicoenteric fistula</span>'''
** <span style="color:#ff0000">'''Trial of medical therapy including intravenous total parenteral nutrition, bowel rest, and antibiotics'''</span> may be warranted. 
***'''May be the preferred initial approach,''' especially in patients with '''Crohn disease, in whom the notion of immediate exploratory laparotomy and bowel resection is often discouraged because of the chronic relapsing nature of the disease'''
* '''<span style="color:#ff0000">Operative management</span>'''
** <span style="color:#ff0000">'''Goal is to separate and close the involved organs with minimal anatomic disruption and normal long-term function of both systems.'''</span>
** '''Both single and multistage procedures have been advocated,''' depending on the clinical circumstances.
*** A one-stage procedure involves removal of the fistula, closure of the involved organs, and primary reanastomosis of the bowel after resection of the involved bowel segment.
*** A two-stage approach advocates removal of the fistula, closure of the involved organs, and creation of a temporary proximal diverting colostomy, with a later return to the operating room for colostomy takedown once the fistula tract has been demonstrated to be closed