What is that in your urine?

I have a patient right now who is an 87 year old man who has a history of prostate cancer for which he had a TURP = transurethral resection of the prostate. He has a bunch of other illnesses as well. He presented to the ER with abdominal pain and suprapubic pain a couple of days ago. I have been working him up to figure out why he has had this abdominal pain. He is extremely sick and probably not going to make it much longer. We did a bunch of imaging studies looking for a small bowel obstruction or diverticulitis or a colon caner, etc. but nothing showed up in any of the studies. 

The other day I put a catheter in hi so that I could monitor his urine output and watch his kidney function. He is incontinent so I figured a catheter would be win win. Yesterday I noticed that his urine was rather clumpy and dark in color and looked like it had something floating in it. I sent the urine out for analysis and order some imaging of his abdomen and pelvis. It turns out the clumpiness in his urine is fecal matter and the imaging showed a rectovessicular fistula had formed. Basically a hole in his rectum and his bladder formed and a connection between the 2 structures formed. He now passes crap from his rectum into his bladder and out his urethra. I have consulted urology to see if they want to fix it or maybe colorectal surgery will fix it. We have to take into consideration his age and condition. If we determine he is hospice which means we think he has less than 6 month left of life the we will not do the procedure and just try to keep him comfortable. What a crappy situation. It was interesting trying to explain this to his adult children and answer their questions; "you mean there is sh*&# coming out of my dad's d%#%?!!