Background: Colovesical fistulas are abnormal communications between the colon and urinary bladder, most commonly caused by diverticular disease. Although colovesical fistulas are rare, they should be suspected in patients presenting with recurrent urinary tract infections, pneumaturia, or fecaluria. We integrated two case reports with a retrospective national cohort analysis to assess the surgical treatment of colovesical fistulas. Methods: We report two cases of colovesical fistulas, both secondary to sigmoid diverticulitis, treated surgically via minimally invasive approaches. A retrospective analysis using the National Inpatient Sample database from 2016 to 2022 was conducted to compare outcomes of open surgery with those of minimally invasive surgery. Propensity score matching and multivariable regression analyses were used to evaluate clinical outcomes. Results: The first patient underwent hand-assisted laparoscopic sigmoidectomy with fistula takedown and has remained asymptomatic at 8 months, while the second patient underwent robotic-assisted sigmoidectomy with staged ileostomy reversal and has remained asymptomatic at 1 month. National data analysis showed no significant difference in mortality (<1% versus <1%, p = 0.931), wound complications (1.4% versus 1.0%; p = 0.554), or postoperative sepsis or shock (7.1% versus 5.6%; p = 0.114) between open and minimally invasive surgical approaches. However, the minimally invasive surgery group had significantly shorter length of stay than the open surgery group (6.9 versus 7.3 days, p < 0.001). Conclusions: Minimally invasive repair of colovesical fistulas was associated with shorter hospital stays than open surgery, with no significant differences in major complications. Early identification and timely surgical management are critical for achieving favorable outcomes.

BACKGROUND: Colorectal cancer incidence is increasing among adults under age 50, yet the etiologic drivers remain unclear. The All of Us Research Program provides a unique opportunity to examine age-specific genetic and environmental associations with colorectal cancer risk in a diverse national cohort. OBJECTIVE: To determine whether a significant association exists between traditional environmental risk factors and established genetic variants and age-specific incidence patterns of early-onset colorectal cancer. DESIGN: Retrospective stratified case-control study using whole genome sequencing and electronic health records. Conditional logistic regression adjusted for genetic ancestry. SETTINGS: Diverse national cohort with integrated genomic data, electronic health records, and lifestyle surveys. PATIENTS: A total of 2,455 colorectal cancer patients (485 early-onset diagnosed before age 50, 1,970 late-onset diagnosed at age ≥50) matched 4:1 to 9,820 controls on birth year, sex, and race. MAIN OUTCOME MEASURES: Age-specific associations between environmental factors (family history, smoking timing, alcohol use disorders, body mass index) and 283 genetic variants with colorectal cancer risk. RESULTS: Family history was associated with higher odds uniformly across ages (odds ratio 2.10, 95% confidence interval 1.69-2.61). Heavy smoking during ages 20-40 was associated with late-onset but not early-onset disease (interaction p = 0.006). Alcohol use disorders and body mass index showed no age-specific effects. In genetic analyses, no variants demonstrated age-specific effects after correction for multiple comparisons (283 variants tested). No genetic pathways differed between early-onset and late-onset disease. Two variants were associated with rectal-specific risk (VTI1A rs4554812, FMN2 rs2078095). LIMITATIONS: Causal inference is limited by observational design. Self-reported exposures are subject to recall bias. Age-stratified analyses had limited power for rare genetic effects. CONCLUSIONS: Traditional environmental risk factors and established common genetic variants are not associated with the rising incidence of early-onset colorectal cancer. Thus, drivers of early-onset disease might include novel environmental exposures or early-life factors beyond traditional risk assessment. See Video Abstract .