The Latzko transvaginal vesicovaginal fistula repair is a highly effective treatment for even complex fistulae. Our video demonstrates the Latzko technique and its application in a variety of circumstances including fistula management concurrent with treatment of uterovaginal prolapse, following 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 (Figure 1A). 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 (Figure 1B). Finally, the vaginal epithelium is closed (Figure 1C).
American journal of obstetrics and gynecology. 2019 May 20 [Epub ahead of print]
Caroline Kieserman-Shmokler, Anne G Sammarco, Emily M English, Carolyn W Swenson, John O Delancey
University of Michigan Department of Obstetrics and Gynecology. Electronic address: ., University of Michigan Department of Obstetrics and Gynecology; Rush University Department of Obstetrics and Gynecology (present location)., University of Michigan Department of Obstetrics and Gynecology.