Dataset Information

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

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.

SUBMITTER: Kieserman-Shmokler C

PROVIDER: S-EPMC6667282 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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

Kieserman-Shmokler Caroline C Sammarco Anne G AG English Emily M EM Swenson Carolyn W CW DeLancey John O JO

American journal of obstetrics and gynecology 20190520 2

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-diss ...[more]

PMID: 31121139

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Project description:OBJECTIVE:To develop a risk score to identify women with vesicovaginal fistula at high risk of residual urinary incontinence after surgical repair. METHODS:We conducted a prospective cohort study among 401 women undergoing their first vesicovaginal fistula repair at a referral fistula repair center in Lilongwe, Malawi, between September 2011 and December 2014, who returned for follow-up within 120 days of surgery. We used logistic regression to develop a risk score to identify women with a high likelihood of residual urinary incontinence, defined as incontinence grade 2-5 within 120 days of vesicovaginal fistula repair, based on preoperative clinical and demographic characteristics (age, number of years with fistula, human immunodeficiency virus status, body mass index, previous repair surgery at an outside facility, revised Goh classification, Goh vesicovaginal fistula size, circumferential fistula, vaginal scaring, bladder size, and urethral length). The sensitivity, specificity, and positive and negative predictive values of the risk score at each cut point were assessed. RESULTS:Overall, 11 (3%) women had unsuccessful fistula closure. Of those with successful fistula closure (n=372), 85 (23%) experienced residual incontinence. A risk score cut point of 20 had sensitivity of 82% (95% confidence interval [CI] 72-89%) and specificity 63% (95% CI 57-69%) to potentially identify women with residual incontinence. In our population, the positive predictive value for a risk score cut point of 20 or higher was 43% (95% CI 36-51%) and the negative predictive value was 91% (95% CI 86-94%). Forty-eight percent of our study population had a risk score 20 or greater and, therefore, would have been identified for further intervention. CONCLUSION:A risk score of 20 or higher was associated with an increased likelihood of residual incontinence with satisfactory sensitivity and specificity. If validated in alternative settings, the risk score could be used to refer women with a high likelihood of postoperative incontinence to more experienced surgeons.

Project description:BackgroundResearch on the use of tissue interposition flaps (TIFs) in vesicovaginal fistulae (VVF) repair is a broad area where a very wide range of natural and synthetic materials have been used. The occurrence of VVF is also diverse in the social and clinical settings, resulting in a parallel heterogeneity in the published literature on its treatment. The use of synthetic and autologous TIFs in VVF repair is not yet standardized with a lack of the most efficacious type and technique of the TIF.ObjectivesThe aim of this study was to systematically review all synthetic and autologous TIFs used in the surgical repair of VVFs.Data sources and methodsIn this scoping review, the surgical outcomes of autologous and synthetic interposition flaps used in VVF treatment meeting the inclusion criteria were determined. We searched the literature using Ovid MEDLINE and PubMed databases between 1974 and 2022. Study characteristics were recorded, and data on the change in fistulae size and location, surgical approach, success rate, preoperative patient evaluation and outcome evaluation were extracted from each study independently by two authors.ResultsA total of 25 articles that met the inclusion criteria were included in the final analysis. A total of 943 and 127 patients who had received autologous and synthetic flaps, respectively, were included in this scoping review. The fistulae characteristics were highly variable with regard to their size, complexity, aetiology, location and radiation. Outcome assessments of fistulae repair in included studies were mostly based on symptom evaluation. Physical examination, cystogram and methylene blue test were the methods in order of preference. Postoperative complications, such as infection, bleeding, donor site, pain, voiding dysfunction and other complications, were reported in patients after fistulae repair in all included studies.ConclusionThe use of TIFs in VVF repair was common especially in complex and large fistulae. Autologous TIFs appear to be the standard of care at the moment, and synthetic TIFs were investigated in prospective clinical trials in a limited number of selected cases. Evidence levels of clinical studies evaluating the effectiveness of interposition flaps were overall low.

Dataset Information

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

Publications

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

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