DOI: 10.12688/f1000research.186340.1 ISSN: 2046-1402

Impact of bladder repair on postoperative outcomes in the surgical management of colovesical fistula: a systematic review and meta-analysis

Saad Dhafer Alshahrani, Nora Khaled Al Shehri, Ahmed Moustafa Aboaly, Turki Saeed F Alshahrani, Khaled Yahya A Hader, Hani Alasmari, Razan Al-Hufayyan, Hayam Almadani, Zyad Khaloofah S. Alshehri, Tasnim Abu Shaqah, Ehab Sharyan, Feras Ibrahim A Alshehri, Khalid Ali Bakri, Atheer Ali Mobasher
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Background Colovesical fistula is the most common type of enterovesical fistula and is associated with significant morbidity. Surgical management typically involves resection of the diseased bowel, with or without bladder repair. However, the necessity of routine bladder repair remains controversial. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to February 2026. Observational studies and case series including adult patients undergoing surgery for colovesical fistula were included. The primary outcome was postoperative urinary leak. A random-effects model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results Twelve studies comprising patients with colovesical fistula were included. Meta-analysis of five studies demonstrated no significant difference in urinary leak between bladder repair and no repair groups (OR = 1.93, 95% CI: 0.42–8.81; I 2  = 0%). Sensitivity analysis excluding mixed etiology studies showed consistent findings (OR = 2.02, 95% CI: 0.24–16.62; I 2  = 10.6%). Fistula recurrence was rare across studies, while complications and length of hospital stay were variably reported and could not be pooled. Most studies had moderate risk of bias. Conclusions Bladder repair was not associated with reduced postoperative urinary leak in colovesical fistula surgery. A selective approach to bladder management may be sufficient in appropriately selected patients. Further prospective studies are needed to establish optimal surgical strategies.

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