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THE LATZKO OPERATION FOR VESICO‐VAGINAL FISTULAE

Vesico-vaginal fistulae are seen infrequently in developed countries, the main causes of operable fistulae being injuries due to hysterectomy, radical hysterectomy, or radiotherapy for carcinomas of the cervix. The operative approach depends on many factors such as the size and localization of the defect aetiology of the fistula, presence or absence of other lesions in the lower urinary tract or bowel. Many techniques and approaches have been proposed. For the uncomplicated vesico-vaginal fistula the approach preferred by gynecologists is the vaginal one, either the Fueth operation in German speaking countries or the SIMS procedure in the English speaking world. A good alternative especially in the posthysterectomy fistula, but also in other fistulae, is the Latzko procedure. Latzko (8) described this operation in 1913 and called it high occlusion of the vagina. He had used it successfully in 3 cases: 1 with a recto-vaginal and 2 with vesico-vaginal fistulae. Independently Wertheim is said to have used the same method. Later the operation seems to have been almost forgotten until Falk (4) rediscovered it. The Latzko procedure has definite advantages over the Sims or the Fueth operation in cases of highly situated, relatively inaccessible fistulae. These advantages are (12): a high success rate, technical ease, little shortening of the vagina. The Latzko procedure may also be performed for smaller radiation fistulae. In these cases the colpocleisis has to be more extensive.