Early Foley Catheter Removal after Segmental Colectomy With Colovesical Fistula Closure for Patients With Complicated Diverticulitis

Objective: To evaluate the safety of early Foley catheter removal after segmental colectomy with colovesical fistula (CVF) closure in patients with diverticulitis. Summary Background Data: CVF secondary to diverticulitis are typically treated with segmental resection and CVF closure, followed by postoperative bladder decompression using a Foley catheter. Prolonged catheterization increases urinary tract infection risk, but the optimal duration of catheterization remains unclear. Methods: This single-arm prospective trial (NCT05235204), conducted at a tertiary academic center from 6/2019-10/2025, included patients undergoing segmental colectomy with CVF closure for diverticular CVF. All patients underwent intraoperative bladder leak testing followed by cystography on postoperative day 2 or 3, with Foley catheter removal if no extravasation was identified. The primary outcome was bladder leak, evidenced by contrast extravasation on postoperative cystogram; secondary outcomes included Foley catheter reinsertion, CVF recurrence, and 30- and 90-day postoperative complications. Results: 65 patients were studied. Of these, 56 (86.2%) underwent CVF closure without bladder repair, seven (10.8%) required single-layer bladder repair, and two (3.1%) required two-layer bladder repair. All post-repair intraoperative leak tests were negative. Early Foley removal on postoperative day 2 or 3 was achieved in 59 patients (90.8%). All postoperative cystograms were negative for contrast extravasation. There were no Foley reinsertions or CVF recurrences. Readmission occurred in 4 patients (6.2%) within 30 days and 7 (10.8%) within 90 days. Conclusions: Our study demonstrates the safety of early Foley removal, with no bladder leaks, Foley reinsertions, or CVF recurrences observed. Early Foley removal should be considered for adoption as routine clinical practice following closure of CVF due to diverticulitis.