37 The latzko procedure: A classic approach to vesicovaginal fistula repair

The objective of this video is to review the Latzko partial colpocleisis procedure for the management of vesicovaginal fistula. The Latzko procedure, inspired by partial vaginectomies, is a low morbidity, simple, highly effective technique for repair of vesicovaginal fistula. This video considers several key aspects to ensure successful repair. First, optimal patient selection is necessary, paying particular attention to vaginal length for sexually-active women, exposure and descensus of tissue, and distance from the ureteral orifices to avoid the need for potential ureteral reimplantation. Second, helpful tips to assist with the procedure include maximizing exposure and access through the use of a pediatric foley catheter or stay sutures and adequate retraction of surrounding vaginal tissue. Wide denudement of vaginal epithelium is crucial to reapproximate the vesicovaginal adventitia in multiple imbricating tiers to disperse tension across multiple layers. Postoperative considerations are also addressed, including duration of bladder drainage, the use of post-operative antibiotics, and the need for a cystogram to confirm healing. Success rates following a Latzko closure are greater than 90% on the first repair. The Latzko partial colpocleisis is an effective, minimally invasive, versatile, and safe vaginal approach to vesicovaginal fistula repair.