An enterovesical fistula is an abnormal connection between the bowel and bladder, with the most common form being a colovesical fistula that forms between the sigmoid colon and the dome of the bladder. Fistulae are more common in males than females, with a 3:1 male-to-female ratio.

Diverticular disease is the most common underlying disease leading to fistula formation. Other common causes include incomplete separation of the urinary and digestive systems during development, infection in the setting of diverticulitis, inflammatory conditions such as Crohn disease, cancer, trauma, or previous surgical procedures.

Patients with enterovesical fistulae typically present with suprapubic pain, dysuria, frequency, and symptoms of urinary tract infection. Gouverneur syndrome, or suprapubic pain, frequency, dysuria, and tenesmus, are the hallmarks of enterovesical fistulae. Many patients also present with recurrent urinary tract infections not eradicated with multiple courses of antibiotics.

Pneumaturia, or air in the urinary stream, occurs in 50%-60% of patients with enterovesical fistulae and is more common in patients with diverticular disease and Crohn disease than in those with cancer. Fecaluria, or stool in the urine, is pathognomonic and occurs in 40% of patients with fistula, most commonly those with Crohn disease.