Experience with 37 patients with adult colovesical fistula over the past 19 years is reviewed. Specific guidelines for treatment of adult colovesical fistula are influenced by the location and cause of the fistula, the patient's general condition, the presence of a pelvic abscess and the presence of colonic obstruction. When criteria are met, a one-stage procedure is safe. The two-stage approach should enjoy wider application, with the three-stage approach reserved for patients who are unprepared or who have a large pelvic abscess. In patients with colovesical fistula due to cancer, the extent of tumor should be carefully evaluated and resection carried out whenever possible. Colovesical fistulas due to trauma, inflammatory bowel disease and iatrogenic causes are often unusual in location; thus treatment must be individualized.
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