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Transvaginal Latzko Repair (Partial Colpocleisis)

The Latzko repair (Wilhelm Latzko, 1942) is a transvaginal partial colpocleisis for vesicovaginal fistula (VVF). It denudes and imbricates the vaginal epithelium surrounding the fistula tract — and critically does not excise the fistula tract itself. It is one of the most widely used and highly effective transvaginal VVF techniques, with reported success 82–100% in non-irradiated patients.[1][2][3][4]

For the broader VVF clinical algorithm, see the vesicovaginal fistula clinical page. For conservative and endoscopy-guided alternatives, see Conservative VVF Management and Endoscopic VVF Management.

Principle​

Latzko originally described the technique for post-hysterectomy VVFs at the vaginal cuff. Rather than dissecting the bladder off the vagina and closing each layer separately (multilayer closure), the Latzko denudes vaginal epithelium circumferentially around the fistula and imbricates the surrounding fibromuscular tissue in multiple layers, obliterating the upper vagina over the fistula site. The tract is left in situ and is sealed by apposition of the raw, denuded surfaces.[1][5]

Indications​

  • Post-hysterectomy (vaginal cuff) VVFs — the classic and most common indication; the apex is where the technique sits most naturally.[5][6][2]
  • Small to moderate-sized fistulae that can be visualized and accessed transvaginally.
  • Fistulae near the ureteral orifices — preferred when ureteral injury risk is a concern, because the technique avoids deep dissection into the vesicovaginal space.[7]
  • Radiation-induced VVF — used in 35.7% of cases in one large series (n = 210 radiation VVFs), particularly when ureteral proximity is a concern.[7]
  • Complex / recurrent fistulae — versatile across concurrent prolapse repair, complex urologic surgery, and the postpartum setting.[5][8]
  • Repeat repairs — acceptable to repeat the Latzko after a prior vaginal failure.[3]

Contraindications / poor fit​

  • Fistula too low (mid-vaginal or distal) for adequate apical denuding and imbrication.
  • Ureteral reimplantation required.
  • Bladder augmentation required.
  • Very large fistula preventing tension-free closure.
  • Concurrent abdominal pathology requiring transabdominal access.[1]
  • Particular concern about vaginal shortening in a sexually active patient (see below).

Surgical Technique​

The classic technique and modifications proceed in this order:[5][6]

1. Positioning and exposure​

  • Dorsal lithotomy (high or exaggerated for optimal exposure).
  • Weighted posterior vaginal retractor and lateral retractors.
  • Identify the fistula and pass a small catheter / probe through the tract to confirm location.
  • Cystoscopy to assess fistula size, location relative to the ureteral orifices, and to place ureteral stents if needed for protection.

2. Hydrodissection​

  • Inject a vasoconstrictor solution (e.g., dilute vasopressin or epinephrine in saline) circumferentially around the fistula into the subepithelial plane.
  • Dual purpose: hydrodissection to elevate vaginal epithelium from underlying fascia, plus hemostasis.[5]

3. Circumscribing incision and denuding​

  • Circumferential incision in vaginal epithelium 2–3 cm from the fistula margin.
  • Sharply dissect the vaginal epithelium within this circle off the underlying pubovesical (endopelvic) fascia, leaving a ring of denuded raw fibromuscular tissue around the fistula.
  • The fistula tract is not excised — the defining feature of the Latzko vs multilayer closure.[1][5]

4. Purse-string closure of the fistula​

  • Purse-string suture (typically 2-0 or 3-0 delayed absorbable — polyglactin or poliglecaprone) placed in fibromuscular tissue just outside the epithelialized tract.
  • Tied to invert the fistula edges and close the tract.[5]

5. Imbrication (layered closure)​

  • Two to three additional layers of interrupted imbricating sutures over the purse-string.
  • Each successive layer imbricates the previous, creating a multilayered tension-free closure.
  • Sutures incorporate anterior and posterior vaginal fibromuscular tissue, bringing the walls together over the fistula site (partial colpocleisis).[5][7]

6. Vaginal epithelial closure​

  • Close the remaining vaginal epithelium over the repair with interrupted or running absorbable sutures.
  • Vaginal pack as needed.[5][6]

7. Catheter​

  • Transurethral Foley for continuous bladder drainage, typically 2–3 weeks.[1][3]

Modified Latzko Techniques​

ModificationDetailOutcome
Apical-VVF modification (Luo & Shen)Addresses the firm transverse scar at the vaginal apex after hysterectomy.100% closure in n = 108 at mean 40.7 months, no immediate or delayed complications.[2]
Modified Latzko with separate pubovesical-fascia closure (Cardenas-Trowers)Mobilizes vaginal mucosa around the fistula, then closes pubovesical fascia and vaginal mucosa as separate layers.Adds a distinct fascial layer to the repair.[6]
Latzko + Martius flap interpositionLabial fat-pad flap interposed between bladder and vaginal walls for additional blood supply and bulk.One radiation-induced recurrent VVF salvaged on third Latzko after two failures, with Martius adjunct.[9]

Outcomes​

SeriesnFistula typeSuccessFollow-up
Luo & Shen 2019[2]108Apical (post-hysterectomy)100%Mean 40.7 mo
Mohr 2014[4]60 (transvaginal)Mixed82%6 mo
Pushkar 2009[7]75 (Latzko)Radiation-induced48.1% primary, 80.4% cumulative>40-yr experience
Angioli 2003 (literature review)[3]—Non-irradiated91% mean (vaginal approach)Variable
Kieserman-Shmokler 2019[5]Case seriesComplex / diverseHighly effectiveVariable

Key takeaways:

  • In non-irradiated patients, success 82–100% — comparable to transabdominal approaches.[4][3][2]
  • In radiation-induced VVF, primary success drops to ~48%; cumulative reaches 80% with repeat operations. Latzko is preferred over other vaginal techniques when ureteral-damage risk is present.[7]
  • The Latzko is repeatable — a second or third attempt is acceptable, with or without Martius adjunct.[7][9]

Advantages​

  • Simplicity and reproducibility — minimal variation across diverse scenarios.[5][6]
  • No fistula excision — avoids enlarging the defect or injuring adjacent structures (ureters, bladder).[1]
  • Minimal blood loss — no deep vesicovaginal dissection.[1][4]
  • Shorter operative time vs transabdominal approaches.[4]
  • Shorter hospital stay — typically 1–3 days.[1][4]
  • Less postoperative pain vs abdominal repair.[1]
  • Reduced ureteral-injury risk — no wide vesicovaginal mobilization.[7]
  • Versatility — concurrent prolapse repair, postpartum injury, post-urologic surgery, radiation-induced fistulae.[5]
  • A "high-value, versatile" repair — feasible in outpatient or short-stay settings.[5]

Disadvantages and Concerns​

Vaginal shortening​

The principal concern. The Latzko is by definition a partial colpocleisis — obliteration of the upper vagina — which shortens the canal. This is a theoretical concern for sexually active patients. A comparative transvaginal-vs-transabdominal study, however, found sexual function significantly improved after both, with no difference in FSFI at 6 months.[4] Broader vaginal-surgery literature also shows that vaginal shortening does not consistently correlate with impaired sexual function.[10][11]

Other​

  • Not suitable for all fistula locations — the classic Latzko targets apical / cuff fistulae; mid-vaginal or distal fistulae may not be amenable.
  • Tract not excised — a theoretical concern about incomplete healing or recurrence; not borne out clinically in non-irradiated fistulae.

Latzko vs Multilayer Closure​

FeatureLatzko (Partial Colpocleisis)Multilayer Closure
Fistula tract excisionNoDebated (some excise; some freshen edges)
Vesicovaginal-space dissectionMinimalWide mobilization required
Closure layersImbrication of denuded fibromuscular tissueSeparate bladder (1–2 layers) + vaginal wall
Vaginal shorteningYes (partial colpocleisis)Minimal
Ureteral-injury riskLowerHigher (wider dissection)
Success (non-irradiated)82–100%70–100%
Best suited forApical / cuff fistulaeAny vaginal-fistula location

The Cochrane systematic review on surgical interventions for VVF identified the comparison of partial colpocleisis (Latzko) vs multilayer closure as one of the most important comparisons to evaluate, though high-quality comparative data remain limited.[1]

Postoperative Care​

  • Continuous Foley for 14–21 days; some protocols use 7 days for simple repairs (Barone 2015 RCT non-inferiority).[4]
  • Anticholinergics to suppress bladder spasms.
  • Avoid straining, heavy lifting, and intercourse for 6–8 weeks.
  • Dye test before catheter removal to confirm closure.
  • Follow-up cystoscopy at 6 weeks to 3 months.
  • If the dye test is positive at the planned removal time, extend catheterization 7 additional days — closure rate ~55.7% in extended-catheterization data.

Radiation-Induced VVF​

In the largest reported series (n = 216, 210 vaginal repairs), the Latzko was used in 35.7% of cases. Primary repair succeeded in only 48.1%, but cumulative success with repeat operations reached 80.4%. The authors recommend multistep closure — progressively reducing fistula size with tissue recovery between attempts. Latzko is preferred when ureteral-damage risk is present; the Martius flap when additional vascularized tissue is needed.[7]

See Also​

References​

1. Okada Y, Matsushita T, Hasegawa T, et al. Surgical interventions for treating vesicovaginal fistula in women. Cochrane Database Syst Rev. 2026;1:CD015413. doi:10.1002/14651858.CD015413

2. Luo DY, Shen H. Transvaginal repair of apical vesicovaginal fistula: a modified Latzko technique — outcomes at a high-volume referral center. Eur Urol. 2019;76(1):84–88. doi:10.1016/j.eururo.2019.04.010

3. Angioli R, Penalver M, Muzii L, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol. 2003;48(3):295–304. doi:10.1016/s1040-8428(03)00123-9

4. Mohr S, Brandner S, Mueller MD, Dreher EF, Kuhn A. Sexual function after vaginal and abdominal fistula repair. Am J Obstet Gynecol. 2014;211(1):74.e1–6. doi:10.1016/j.ajog.2014.02.011

5. Kieserman-Shmokler C, Sammarco AG, English EM, Swenson CW, DeLancey JO. The Latzko: a high-value, versatile vesicovaginal fistula repair. Am J Obstet Gynecol. 2019;221(2):160.e1–4. doi:10.1016/j.ajog.2019.05.021

6. Cardenas-Trowers O, Heusinkveld J, Hatch K. Simple and effective: transvaginal vesicovaginal fistula repair with a modified Latzko technique. Int Urogynecol J. 2018;29(5):767–769. doi:10.1007/s00192-017-3471-8

7. Pushkar DY, Dyakov VV, Kasyan GR. Management of radiation-induced vesicovaginal fistula. Eur Urol. 2009;55(1):131–137. doi:10.1016/j.eururo.2008.04.044

8. Roberts BL, Chang ES, Hidalgo RJ, Wiegand LR, Wyman AM. Vesicovaginal fistula repair at the time of colpocleisis. Int Urogynecol J. 2021;32(7):1939–1940. doi:10.1007/s00192-021-04787-x

9. Kołodyńska A, Streit-Ciećkiewicz D, Kot A, Kuliniec I, Futyma K. Radiation-induced recurrent vesicovaginal fistula — treatment with adjuvant platelet-rich plasma injection and Martius flap placement: case report and review of literature. Int J Environ Res Public Health. 2021;18(9):4867. doi:10.3390/ijerph18094867

10. Kim-Fine S, Antosh DD, Balk EM, et al. Relationship of postoperative vaginal anatomy and sexual function: a systematic review with meta-analysis. Int Urogynecol J. 2021;32(8):2125–2134. doi:10.1007/s00192-021-04829-4

11. Occhino JA, Trabuco EC, Heisler CA, Klingele CJ, Gebhart JB. Changes in vaginal anatomy and sexual function after vaginal surgery. Int Urogynecol J. 2011;22(7):799–804. doi:10.1007/s00192-011-1386-3