I guess we all just learned that doing the correct thing does not always result in the correct response by the patient. Anyway, back to our hero... Fecaluria, or its more popular first cousin, pneumaturia, obviously represent a fistula from somewhere in the bowel to somewhere in the urinary tract. With the history given a rectal to bladder fistula is the presumed cause. I say presumed because it has not been proven. If this patient came off the street with this problem he would undergo a detailed history and physical, a ct scan and probably a cysto and a BE or colonoscopy. A fistula caused by, lets say, diverticulitis, would be treated by a sigmoid colostomy, removal of the fistulous tract and closure of the bladder, WITHOUT any form of diversion. Is your patient sick? Is he septic? Does he have a peritoneal or retroperitoneal abscess? These have to be answered before I answer the question. Obviously if he is septic he needs to be drained and exteriorized. I would favor a end sigmoid colostomy; a loop would also do but is tough to bring up. At the later operation a repair of the bladder would be performed along with the further colectomy/ closure of colostomy. However, if your patient is more pissed off than sick (bad pun) than you might consider doing nothing for a few weeks other than giving him outpatient oral antibiotics to lessen the cystitis. Then a 1 stage resection/repair. I recognize that this is a somewhat radical approach, but I think it is correct. The only difference between your patient and the average patient with a diverticular fistula is that you know the exact day the damage was caused. You did the right thing, don't forget.