Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy

Metin Savun; Çağrı Şevik; Emin Taha Keskin; Harun Özdemir; Kemal Topaloğlu; Halil Lütfi Canat

doi:10.70058/cjm.1882558

Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy

Abstract

Objective: To evaluate the surgical outcomes, complication rates, and patient-reported results of the modified Latzko technique for management of supratrigonal vesicovaginal fistulas due to hysterectomy.

Methods: This retrospective study included 25 consecutive patients with supratrigonal vesicovaginal fistulas who underwent hysterectomy between January 2022 and August 2025. All the patients underwent transvaginal repair using the modified Latzko technique. Surgical success was defined as complete resolution of urinary leakage. Patient satisfaction was assessed using the Patient Global Impression of Change scale.

Results: The median patient age was 46 years old. The median interval between symptom onset and repair was seven months, and the median fistula size was 10 mm. The median operative time was 120 minutes. A Martius flap was used in four patients (16.0%). After a median follow-up period of 19 months, the primary surgical success rate was 92.0% (23/25). According to the patient global impression of change scale, 92.0% of patients reported much or very much improvement.

Conclusion: The modified Latzko technique provided high success rates, low morbidity, and excellent patient satisfaction for hysterectomy-related supratrigonal vesicovaginal fistulas. Therefore, it should be considered a first-line option for appropriately selected cases.

Keywords

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Clinical Research Ethics Committee of Başakşehir Çam and Sakura City Hospital (Approval No: KAEK/06.08.2025.265). Written informed consent was obtained from all participants prior to their inclusion in the study.

References

Elneil S, Romanzi L, Goh J, Haylen B, Chen CCG, Ghoniem G, et al. An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas. Neurourol Urodyn. 2020;39(8):2040-71. doi:10.1002/nau.24508.
Hillary CJ, Osman NI, Hilton P, Chapple CR. The aetiology, treatment, and outcome of urogenital fistulae managed in well- and low-resourced countries: a systematic review. Eur Urol. 2016;70(3):478-92. doi:10.1016/j.eururo.2016.02.015.
Malik MA, Sohail M, Malik MT, Khalid N, Akram A. Changing trends in the etiology and management of vesicovaginal fistula. Int J Urol. 2018;25(1):25-9. doi:10.1111/iju.13419.
Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet. 2007;99(Suppl 1):S10-5. doi:10.1016/j.ijgo.2007.06.011.
Srivastava M, Mittal A, Panwar VK, Bahurupi Y, Mandal AK. Transvaginal repair of supratrigonal, juxtacervical, vault, and apical vesicovaginal fistulae: a systematic review and meta-analysis. Urol Res Pract. 2025;51(3):117-30. doi:10.5152/tud.2025.24184.
Kızılay F, Özdemir T, Aliyev B, Şimşir A, Kalemci S, Özyurt C. Comparison of the abdominal and transvaginal techniques in the surgical treatment of vesicovaginal fistula and analyzing the factors affecting its recurrence. J Urol Surg. 2020;7(3):238-44. doi:10.4274/jus.galenos.2020.3182.
Gedik A, Deliktas H, Celik N, Kayan D, Bircan MK. Which surgical technique should be preferred to repair benign, primary vesicovaginal fistulas? Urol J. 2015;12(6):2422-7. doi:10.22037/uj.v12i6.3061.
Thompson JC, Halder GE, Jeppson PC, Alas A, Balgobin S, Dieter AA, et al. Repair of vesicovaginal fistulae: a systematic review. Obstet Gynecol. 2024;143(2):229-41. doi:10.1097/AOG.0000000000005468.

Latzko W. Postoperative vesicovaginal fistulas: genesis and therapy. Am J Surg. 1942;58(2):211-28.
Chinthakanan O, Sirisreetreerux P, Saraluck A. Vesicovaginal fistulas: prevalence, impact, and management challenges. Medicina (Kaunas). 2023;59(11):1947. doi:10.3390/medicina59111947.
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.
Luo DY, Shen H. Transvaginal repair of apical vesicovaginal fistula: a modified Latzko technique-outcomes at a highvolume referral center. Eur Urol. 2019;76(1):84-8. doi:10.1016/j.eururo.2019.04.010.
Cardenas-Trowers O, Heusinkveld J, Hatch K. Simple and effective: transvaginal vesico-vaginal fistula repair with a modified Latzko technique. Int Urogynecol J. 2018;29:767-9. doi:10.1007/s00192-017-3471-8.
Butler BM, Adam RA, Giri A. Incidental urinary tract injury and the formation of vesicovaginal fistula at the time of hysterectomy for benign indications. Int Urogynecol J. 2023;34:391-8. doi:10.1007/s00192-022-05367-3.
Duong TH, Taylor DP, Meeks GR. A multicenter study of vesicovaginal fistula following incidental cystotomy during benign hysterectomies. Int Urogynecol J. 2011;22:975-9. doi:10.1007/s00192-011-1375-6.
Panaiyadiyan S, Nayyar BU, Nayyar R, Kumar N, Seth A, Kumar R, et al. Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up. Int Urogynecol J. 2021;32:2521-8. doi:10.1007/s00192-020-04648-z.
Theofanides MC, Sui W, Sebesta EM, Onyeji I, Matulay JT, Chung DE. Vesicovaginal fistulas in the developed world: an analysis of disease characteristics, treatments, and complications of surgical repair using the ACS-NSQIP database. Neurourol Urodyn. 2017;36(6):1622-8. doi:10.1002/nau.23167.
Jefferson FA, Hanson KT, Robinson MO, Habermann EB, Madsen AM, Gebhart JB, et al. Perioperative outcomes of vesicovaginal fistula repair by surgical approach. Urogynecology (Phila). 2024;30(2):114-22. doi:10.1097/SPV.0000000000001394.
Bodner-Adler B, Hanzal E, Pablik E, Koelbl H, Bodner K. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: a systematic review and meta-analysis. PLoS One. 2017;12(2):e0171554. doi:10.1371/journal.pone.0171554.
Iyer SM, Singh S, Srivastav A. Analysis of various surgical approaches to supratrigonal vesicovaginal fistula repair: a tertiary care centre experience. Int Urogynecol J. 2025;36(6):1273-9. doi:10.1007/s00192-025-06104-2.
Klemm J, Stelzl DR, Schulz RJ, Marks P, Shariat SF, Fisch M, et al. Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review. BJU Int. 2024;134(3):407-15. doi:10.1111/bju.16395.
Matei DV, Zanagnolo V, Vartolomei MD, Crisan N, Ferro M, Bocciolone L, et al. Robot-assisted vesico-vaginal fistula repair: our technique and review of the literature. Urol Int. 2017;99(2):137-42. doi:10.1159/000475887.
Xiong Y, Tang Y, Huang F, Liu L, Zhang X. Transperitoneal laparoscopic repair of vesicovaginal fistula for patients with supratrigonal fistula: comparison with open transperitoneal technique. Int Urogynecol J. 2016;27:1415-22. doi:10.1007/s00192-016-2957-0.
Anand M, Kumar M, Jain M, Gupta A, Kumar A, Singh BP, et al. Early bladder dysfunction after vesicovaginal fistula repair: a prospective comparative analysis of transvaginal, open, and laparoscopic abdominal approaches. Neurourol Urodyn. 2024;43(8):2101-9. doi:10.1002/nau.25548.
Randazzo M, Lengauer L, Rochat CH, Ploumidis A, Kröpfl D, Rassweiler J, et al. Best practices in robotic-assisted repair of vesicovaginal fistula: a consensus report from the European Association of Urology Robotic Urology Section Scientific Working Group for Reconstructive Urology. Eur Urol. 2020;78(3):432-42. doi:10.1016/j.eururo.2020.06.029.

Details

Primary Language

English

Subjects

Urology

Journal Section

Research Article

Authors

Metin Savun
0000-0003-4434-9661
Türkiye

Çağrı Şevik ^*
0000-0003-0288-704X
Türkiye

Emin Taha Keskin
0000-0002-1222-6424
Türkiye

Harun Özdemir
0000-0002-3071-910X
Türkiye

Kemal Topaloğlu
0000-0002-5604-1608
Türkiye

Halil Lütfi Canat
0000-0001-6481-7907
Türkiye

Early Pub Date

May 24, 2026

Publication Date

May 31, 2026

Submission Date

February 5, 2026

Acceptance Date

May 16, 2026

Published in Issue

Year 2026 Volume: 3 Number: 2

DOI

https://doi.org/10.70058/cjm.1882558

IZ

https://izlik.org/JA46AT38BY

Cite

RIS / Bibtex

APA

Savun, M., Şevik, Ç., Keskin, E. T., Özdemir, H., Topaloğlu, K., & Canat, H. L. (2026). Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy. Cerasus Journal of Medicine, 3(2), 140-146. https://doi.org/10.70058/cjm.1882558

AMA

1.Savun M, Şevik Ç, Keskin ET, Özdemir H, Topaloğlu K, Canat HL. Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy. Cerasus J Med. 2026;3(2):140-146. doi:10.70058/cjm.1882558

Chicago

Savun, Metin, Çağrı Şevik, Emin Taha Keskin, Harun Özdemir, Kemal Topaloğlu, and Halil Lütfi Canat. 2026. “Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy”. Cerasus Journal of Medicine 3 (2): 140-46. https://doi.org/10.70058/cjm.1882558.

EndNote

Savun M, Şevik Ç, Keskin ET, Özdemir H, Topaloğlu K, Canat HL (May 1, 2026) Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy. Cerasus Journal of Medicine 3 2 140–146.

IEEE

[1]M. Savun, Ç. Şevik, E. T. Keskin, H. Özdemir, K. Topaloğlu, and H. L. Canat, “Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy”, Cerasus J Med, vol. 3, no. 2, pp. 140–146, May 2026, doi: 10.70058/cjm.1882558.

ISNAD

Savun, Metin - Şevik, Çağrı - Keskin, Emin Taha - Özdemir, Harun - Topaloğlu, Kemal - Canat, Halil Lütfi. “Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy”. Cerasus Journal of Medicine 3/2 (May 1, 2026): 140-146. https://doi.org/10.70058/cjm.1882558.

JAMA

1.Savun M, Şevik Ç, Keskin ET, Özdemir H, Topaloğlu K, Canat HL. Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy. Cerasus J Med. 2026;3:140–146.

MLA

Savun, Metin, et al. “Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy”. Cerasus Journal of Medicine, vol. 3, no. 2, May 2026, pp. 140-6, doi:10.70058/cjm.1882558.

Vancouver

1.Metin Savun, Çağrı Şevik, Emin Taha Keskin, Harun Özdemir, Kemal Topaloğlu, Halil Lütfi Canat. Outcomes of Modified Latzko Technique in the Management of Supratrigonal Vesicovaginal Fistulas Due to Hysterectomy. Cerasus J Med. 2026 May 1;3(2):140-6. doi:10.70058/cjm.1882558