Editing Functional: Urinary Fistulae (section)

=== Pyeloenteric fistulae ===

==== Causes ====
*'''Most common cause has historically been chronic inflammatory disease, such as xanthogranulomatous pyelonephritis or other infectious diseases involving the kidney or bowel.''' '''However, iatrogenic surgical trauma, especially that related to percutaneous renal surgery and percutaneous nephrolithotomy (PCNL), has been associated with an increasing number of such fistulae'''
* '''Right-sided pyeloenteric fistulae most often involve the duodenum, whereas left-sided pyeloenteric fistulae most commonly involve the descending colon'''

==== Diagnosis and Evaluation ====
*'''Majority of patients have nonspecific symptoms,''' including malaise, nonspecific GI symptoms, urinary frequency, flank mass, or tenderness.

==== Management ====
* A large nephrostomy tube, enteric suction or bowel rest, antibiotics, and removal of any foreign body (e.g., a stone) may be attempted. Internal stenting of the urinary tract may be pursued for maximal drainage.
* Fistulae associated with a poorly functioning kidney are best treated by primary closure of the bowel and nephrectomy.