Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug;221(2):160.e1-160.e4.
doi: 10.1016/j.ajog.2019.05.021. Epub 2019 May 20.

The Latzko: A high-value, versatile vesicovaginal fistula repair

Caroline Kieserman-Shmokler  1 , Anne G Sammarco  2 , Emily M English  2 , Carolyn W Swenson  2 , John O DeLancey  2
Affiliations

The Latzko: A high-value, versatile vesicovaginal fistula repair

Caroline Kieserman-Shmokler et al. Am J Obstet Gynecol. 2019 Aug.

Abstract

The Latzko transvaginal vesicovaginal fistula repair is a highly effective treatment for even complex fistulae. Our video demonstrates the Latzko repair technique and its application in a variety of circumstances that include fistula management concurrent with treatment of uterovaginal prolapse, after complex urologic surgery, and in the postpartum setting after urologic injury. The technique of the procedure varies only slightly in these diverse conditions. The basic steps begin with hydro-dissecting the epithelium from the underlying fascia surrounding the fistula tract, followed by denuding the epithelium within a circumscribing incision around the fistula. The fistula is then closed with a purse-string suture placed just outside the epithelialized tract. Next, several layers of imbricating sutures are placed to close the defect. Finally, the vaginal epithelium is closed.

Keywords: complex fistula; prolapse; vesicovaginal fistula.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.. Basic Latzko steps
A) The epithelium is denuded within the circumscribed area. B) Several imbricating suture layers are placed. C) Vaginal epithelium is closed.
Figure 2.
Figure 2.. Large vaginal vault prolapse with vesicovaginal fistula following hysterectomy
A) The fistula is easily visualized after instilling methylene blue into the bladder. B) The diamond-shaped incision for Michigan 4-wall sacrospinous ligament suspension is outlined medial to the fistula repair site.
Figure 3.
Figure 3.. Vesicovaginal fistula lateral to the cervix
A) Preoperative: vesicovaginal fistula following hysterectomy is located lateral to the cervix. B) Postoperative: Latzko fistula repair is completed.
Figure 4.
Figure 4.. Complex fistula between a bladder diverticulum and the vagina (fluoroscopy)
Figure 5.
Figure 5.. Complex fistula before and after Latzko repair
A) Preoperative: Pediatric Foley catheter is placed though the vesicovaginal fistula, and there is a chronic cervical laceration at 12 o’clock. B) Postoperative: Latzko vesicovaginal fistula repair and cervical laceration closure are completed.
See this image and copyright information in PMC

References

    1. Ansquer Y, Mellier G, Santulli P, et al. Latzko operation for vault vesicovaginal fistula. Acta Obstet Gynecol Scand 2006;85(10):1248–1251. - PubMed
    1. Tancer ML. The Post-Total Hysterectomy (Vault) Vesicovaginal Fistula. The Journal of Urology 1980;123(6):839–840. - PubMed
    1. Bodner-Adler B, Hanzal E, Pablik E, Koelbl H, Bodner K. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis. PLoS One 2017;12(2):e0171554. - PMC - PubMed
    1. Gedik A, Deliktas H, Celik N, Kayan D, Bircan MK. Which Surgical Technique Should be Preferred to Repair Benign, Primary Vesicovaginal Fistulas? Urol J 2015;12(6):2422–2427. - PubMed
    1. Crosby EC, Berger MB, Delancey JO. Vaginal approach to vesicovaginal fistula and vaginal vault prolapse preserving sexual function by Latzko repair and sacrospinous suspension. Female Pelvic Med Reconstr Surg 2012;18(5):306–307. - PMC - PubMed

Publication types

MeSH terms