Partial Colpocleisis Research Articles

V173 MODIFIED LATZKO PROCEDURE (PARTIAL COLPOCLESIS) FOR VESICOVAGINAL FISTULA: TECHNIQUE AND OUTCOMES

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2010V173 MODIFIED LATZKO PROCEDURE (PARTIAL COLPOCLESIS) FOR VESICOVAGINAL FISTULA: TECHNIQUE AND OUTCOMES Denise Chow, Ahmet Bedestani, Ralph Chesson, and Jack Christian Winters Denise ChowDenise Chow More articles by this author , Ahmet BedestaniAhmet Bedestani More articles by this author , Ralph ChessonRalph Chesson More articles by this author , and Jack Christian WintersJack Christian Winters More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.228AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Modified Latzko procedure historically has been a successful approach to transvaginal treatment for VVF. This procedure is reproducible, and can be performed for most fistulas. Our objective is to highlight the principles of the repair and summarize our experience. METHODS 17 patients who presented with fistulas were repaired via the Latzko technique. The video highlights the key components of the procedure including: 1) Adequate exposure of the apex of vagina 2) A circumferential, full thickness dissection of the vaginal wall to expose fistula 3) Isolation and closure of the fistula, 4) Imbricating sutures to complete the partial colpocleisis (serves as interposition) 5) Re-closure of the vaginal cuff. A retrospective chart review was completed to assess outcomes and operative experience. RESULTS 17 patients underwent repair with this technique. Age ranged from 28-80, and 1 patient had failed abdominal repair. 88% were discharged the following day and catheter drainage was maintained for 3-4 weeks. 16 (94%) had successful resolution after the primary repair. 1 had a recurrence 2 years following the primary procedure due to an inclusion cyst. No intraoperative complications occurred, including bowel, ureteral or bladder injury. A blood loss of 600 cc was encountered in 1 patient. No complaints of sexual dysfunction were recorded. CONCLUSIONS The Latzko procedure is a reproducible, efficacious alternative approach to the transvaginal correction of VVF. Results are excellent and complications are minimal. This procedure should be considered as the primary repair of VVF. New Orleans, LA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e70 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Denise Chow More articles by this author Ahmet Bedestani More articles by this author Ralph Chesson More articles by this author Jack Christian Winters More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of colpocleisis on bowel symptoms among women with severe pelvic organ prolapse

Our objective was to evaluate bowel symptoms after colpocleisis. This was a planned ancillary analysis of a prospective, colpocleisis cohort study of 152 women. Those with baseline and 1-year questionnaires (Colorectal-Anal Distress Inventory (CRADI) and the Colorectal-Anal Impact Questionnaire (CRAIQ)) were included. "Bothersome" CRADI symptoms (score>2("moderately", "quite a bit")) were identified. CRADI and CRAIQ scores were compared, and postoperative symptom resolution and new symptom development were measured. Of 121 (80%) subjects with complete data, mean age was 79.2 +/- 5.4 years and all had stage 3-4 prolapse. Procedures performed: partial colpocleisis (61%), total colpocleisis (39%), levator myorrhaphy (71%), and perineorrhaphy (97%). Bothersome bowel symptom(s) were present in 77% at baseline (obstructive (17-26%), incontinence (12-35%) and pain/irritation (3-34%)). All bothersome obstructive and most bothersome incontinence symptoms were less prevalent 1 year after surgery. CRADI and CRAIQ scores significantly improved. The majority of bothersome symptoms resolved (50-100%) with low rates of de novo symptoms (0-14%). Most bothersome bowel symptoms resolve after colpocleisis, especially obstructive and incontinence symptoms, with low rates of de novo symptoms.

Female urology: What method will you select?

When I was a resident, my leader taught me that the gold standard forpatients with stress incontinence is the Marshall–Marchetti–Krantz(MMK) procedure. But a few years later, urologists who could performadvanced techniques showed me needle suspension as the best methodat a urological meeting. Fortunately my boss gave me a chance for ahand-to-hand lesson of the stamay procedure by the specialist. Sincethen, I have been selecting this procedure for a few years. Withoutdoubt, this needle suspension was the gold standard at that time.But now most urologists do not select this technique because of badresults. After I had mastered the technique of tension-free vaginal tape(TVT), I could see the smiling faces of patients after the operation. Atthat time I believed that TVT would be the gold standard for thiscondition. But the present status is what you know.Recently most specialists, including myself, believe that using‘mesh’ is the best operation for patients with pelvic organ prolapse. Isthis tendency good for the patients in the long run? No one can predictthe results of this procedure more than ten years from now.God knows what procedure will be the gold standard in the future.Assistant Professor Yasuyuki Suzuki

Complications of neglected vaginal pessaries: case presentation and literature review

Vaginal pessaries are often used as first-line management of pelvic organ prolapse in women who are poor surgical candidates or who decline surgical repair. Mostly, pessaries are well tolerated but when neglected may lead to serious complications including vesicovaginal and rectovaginal fistulas. An 89-year-old woman presented with a large vesicovaginal fistula resulting from a Gellhorn pessary that had been neglected for 3 years. The base of the pessary had migrated completely inside the bladder and the fistulous opening measured 4 cm. The pessary was extracted under anesthesia using a Schuchardt incision to increase exposure. After 6 weeks of vaginal estrogen treatment, the fistula was successfully repaired using the Latzko partial colpocleisis technique. Neglect of a vaginal pessary can lead to serious complications. Patient education, local estrogen treatment, excellent fitting, and careful follow-up are of paramount importance in prevention of such complications.

Partial colpocleisis for the treatment of sacrocolpopexy mesh erosions

Partial colpocleisis for the treatment of sacrocolpopexy mesh erosions

Partial colpocleisis for the treatment of sacrocolpopexy mesh erosions

The purpose of this study is to describe the outcomes of partial colpocleisis for mesh erosions after sacrocolpopexy. We retrospectively report our surgical management of mesh erosion after sacrocolpopexy. Between 1998 and 2006, we performed 499 sacral colpopexies and treated 21 patients for mesh erosion, including three referrals. Mean (range) time to diagnosis was 10.3 months (1-49). Grafts materials included: Mersilene (13), Prolene (7), and Pelvicol (1). Surgical outcomes were available for 19 patients. Ten (48%) patients were cured by the initial partial colpocleisis, while nine (45%) required a second or third (2, 10%) vaginal operation. All of the second and third vaginal excisions failed. Eight patients had an abdominal excision, and two patients required a second abdominal procedure. The success rate for the first and second abdominal resections was 38% (3/8) and 100% (2/2). Abdominal surgeries had higher blood loss (84 vs 378 cc, p = 0.012) longer hospitalization (outpatient vs 4.2 days p = 0.001), and additional morbidity (18.6%). Potential contributing factors to surgical failure were the presence of Actinomyces and current smoking. We recommend initial transvaginal mesh resection with partial colpocleisis for synthetic mesh erosions after sacrocolpopexy. Vaginal failures may be better served by an abdominal excision. Potential contributors to failure include current smoking and the presence of Actinomyces.

Transvaginal repair of ureterovaginal fistula by Latzko technique

Ureterovaginal fistula is an uncommon but serious sequela of unrecognized distal ureteral injury during pelvic operations. Traditionally, it is managed either by endoscopic internal ureteral stenting or by ureteral reimplantation. We report a case of ureterovaginal fistula that failed to respond to ureteral stenting. Because the patient had a history of several laparotomies and intra-abdominal abscesses, she was at high risk for complications with a transabdominal operation. Therefore, we used transvaginal Latzko partial colpocleisis and successfully resolved the ureterovaginal fistula.

Regret, satisfaction, and symptom improvement: Analysis of the impact of partial colpocleisis for the management of severe pelvic organ prolapse

The purpose of this study was to assess a cohort of patients who underwent a colpocleisis procedure more than 1 year post operation to determine: 1) the proportion of patients who regretted having the procedure, 2) patient satisfaction with the procedure, and 3) changes in symptom severity after surgery. Using the University of Alabama at Birmingham (UAB) Genitourinary Disorders Center database, a prospective analysis was performed on 54 patients who underwent colpocleisis between August 1996 and April 2003. From August to October of 2004, participants were contacted by an investigator not involved with the surgery and were asked 1) "do you regret having your surgery, and, if so, why?," 2) "how satisfied are you with your progress (completely, somewhat, or not)?," and 3) to repeat the short form Incontinence Impact Questionnaire/Urogenital Distress Inventory (IIQ-7/UDI-6). Fifty-nine percent (32/54) of potential candidates participated in the study. Nine percent (3/32) of patients regretted having colpocleisis performed. Fifty-seven percent (16/28) were completely satisfied, 29% (8/28) somewhat satisfied, and 14% (4/28) not satisfied. Mean IIQ score improved significantly from 40.9 (+/-31.7) at baseline to 14.1 (+/-26.7) at last interview (P = .003). Mean UDI score improved significantly from 63.1 (+/-24.3) at baseline to 24.2 (+/-26.7) at last interview (P = .001). There was a negative correlation between change in UDI scores with time since procedure (r = -.397, P = .055) and age (r = -.435, P = .034). Few patients reported regret after partial colpocleisis. There was a high rate of patient satisfaction and significant symptom improvement more than a year post surgery. Stable but smaller improvements were reported with longer time from surgery and increasing age.

オリーブ油に起因したTVT手術後の膀胱結石

Tension-free vaginal tape (TVT), a less-invasive variation of the suburethral sling, has been rapidly gaining popularity worldwide in the treatment of female stress urinary incontinence. We report on two cases of bladder stones composed of fatty acid calcium following TVT operations. Case 1: A 76-year-old woman with a history of hysterectomy due to cervical cancer was suffering from vault prolapse. The insertion of a ring pessary lead to the development of stress urinary incontinence, and she was referred to our hospital. As she was frail, sexually inactive, and elderly, she underwent partial colpocleisis (Le Fort operation) combined with a TVT operation. One-month postoperative videourodynamics and chain cystourethrography (CUG) using olive oil as the lubricant showed cure of incontinence and mild support of the urethra. Her maximum flow rate was 18.8 ml/s and no residual urine was observed. Six months postoperatively she developed postmiction pain and pyuria that were not improved by antibiotics. Cystoscopy showed a small bladder stone, whose removal cured cystitis. Case 2: A 49-year-old woman, with a history of abdominal hysterectomy due to myoma uteri, visited our hospital complaining of stress urinary incontinence. A periurethral collagen injection was only temporarily effective, and she underwent a TVT operation. A 1-month postoperative evaluation including chain CUG using olive oil as the lubricant showed cure of incontinence, mild support of the urethra, a maximum flow rate of 28.8 ml/s, and no residual urine. Two months postoperatively she developed miction pain and pyuria that were solved by removing a small bladder stone. Anti-incontinence surgery increases the risk of developing bladder stones due to either foreign bodies (bladder erosion) or obstruction. However, neither of our cases had these conditions; instead, both bladder stones were composed of fatty acid calcium that appeared to be related to the olive oil used as the lubricant in chain CUG. Only four cases (including ours) of bladder stones composed of fatty acid calcium have been documented, but they may indicate that care is necessary when using olive oil as a contrast medium or lubricant in the urinary tract. When a woman with a history of anti-incontinence surgery has persisting or recurrent cystitis, cystoscopy should be performed to exclude bladder erosion and stones.

Transvaginal needle suspension with lefort colpocleisis for stress incontinence and advanced uterovaginal prolapse in a high-risk patient

Surgical therapy in high-risk patients with advanced symptomatic pelvic floor defects sometimes mandates a compromise in the extent of proposed and desired repairs in favor of procedures that can be performed more rapidly. An 80-year-old woman with disabling genuine stress urinary incontinence and stage IV uterovaginal prolapse who was unable to retain a pessary was at high surgical risk due to ischemic heart disease. Uterovaginal prolapse was treated by LeFort partial colpocleisis, and stress urinary incontinence by transvaginal needle suspension with symptomatic cure and without significant perioperative morbidity. Operating time was 29 minutes and estimated blood loss was 50 ml. The patient was discharged on the second postoperative day with adequate spontaneous voiding and without urinary retention. A combination of partial colpocleisis with transvaginal needle suspension worked well in this case and may represent an effective and rapid surgical option for similar women.

Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: A comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty: Denehy T.R.; Choe J.Y.; Gregori C.A.; Breen J.L.; Elkins T. USA Am. J. Obstet. Gynecol. 1995 173/6 (1697–1702)

Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: A comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty: Denehy T.R.; Choe J.Y.; Gregori C.A.; Breen J.L.; Elkins T. USA Am. J. Obstet. Gynecol. 1995 173/6 (1697–1702)

Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: A comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty

OBJECTIVE: Our purpose was to evaluate and compare the Le Fort partial colpocleisis and posterior colpoperineoplasty with conventional surgical repair in the medically compromised elderly population. STUDY DESIGN: A retrospective sequential series of 21 elderly women with complete uterovaginal prolapse and severe medical illnesses, having failure of conservative management, underwent a modification of the Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty. The patients' ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses, complications, and follow-up were assessed and compared with those of a retrospective group of 42 women with complete uterovaginal prolapse who had a vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty performed by the same surgical team during the same period. RESULTS: The median age of Le Fort partial colpocleisis was 82 years (range 65 to 91 years), whereas median age in the vaginal hysterectomy group was 66 years (range 39 to 80 years) ( p < 0.00). The median time under anesthesia of Le Fort partial colpocleisis was 75 minutes (range 35 to 120 minutes) compared with the vaginal hysterectomy median time of 150 minutes (range 90 to 210 minutes) ( p < 0.00). The median hospital stay for both Le Fort partial colpocleisis and vaginal hysterectomy was 5 days (range. Le Fort partial colpocleisis 4 to 42 days, vaginal hysterectomy 4 to 14 days). The median decrease in hemoglobin in the Le Fort partial colpocleisis group was 2.2 gm/dl (range 0.2 to 3.6 gm/dl) and 2.8 gm/dl (range 0.9 to 4.5 gm/dl) ( p = 0.51). The complications were comparable with the exception of one postoperative death in the Le Fort partial colpocleisis group. A total of 95% ( 19 20 ) of Le Fort partial colpocleisis patients had excellent results with a median follow-up of 25 months (range 4 to 40 months). CONCLUSION: In this preliminary assessment the modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty offers significant advantages in a select population of elderly, medically compromised patients in whom conservative management is not feasible.

Transvaginal Repair of Enterocele

The urologist actively involved in the treatment of female genitourinary disease must to be able to recognize and treat various forms of pelvic prolapse. Enterocele is commonly seen in conjunction with stress urinary incontinence and cystocele or it may result from surgery to correct these problems. Many techniques to correct enterocele have been developed, including transvaginal repairs as well as intra-abdominal procedures such as the Moschcowitz technique or colpofixation to the sacrum for enterocele with vault prolapse. Surgical management of enterocele must take into account several factors, including the presence of stress urinary incontinence, rectocele, vaginal vault prolapse, prior hysterectomy and the desire to maintain sexual activity. Based on these considerations we discuss our approach to the transvaginal repair of enterocele. In patients without vault prolapse a simple enterocele repair is performed. If vault prolapse is present, then the condition of the anterior vaginal wall is considered. In patients with a cystocele a vault suspension procedure is performed, which involves simultaneous suspension of the uterosacral-cardinal ligament complex and vaginal vault along with the bladder neck and bladder. There are 2 modifications of this technique depending on the degree of cystocele: the 4-corner vault suspension for grades 2 and 3 cystocele, and the vault suspension with grade 4 cystocele repair. Patients with vault prolapse and no cystocele undergo sacrospinous ligament fixation. In elderly patients who are not sexually active, especially if they are in poor medical condition, partial colpocleisis is considered. In these patients partial colpocleisis was not performed as a primary procedure but it was done later in 3 who failed an initial attempt at repair. All coexisting vaginal pathology is fixed at the time of enterocele repair. A total of 83 patients underwent enterocele repair according to this protocol and 81 were available for followup. Mean followup was 15 months (range 3 to 70). Overall a successful result (no recurrence) was achieved in 70 patients (86%). Success for individual procedures was 40 of 49 (82%) for simple repair, 24 of 25 (96%) for vault suspension and 6 of 7 (86%) for sacrospinous fixation. In all cases vault suspension or sacrospinous fixation was able to restore vaginal depth and axis with minimal or no vaginal shortening.

The Neugebauer-Le Fort Operation

The Neugebauer-Le Fort operation or partial colpocleisis is a safe, simple and rapid procedure for the repair of uterine prolapse in elderly women who are poor surgical risks. The operation was performed in 188 women with total procidentia. Good anatomic results were obtained in 90.7% of the women. Late complications were rare, including recurrence of prolapse (3 patients), and urinary incontinence (12 patients). Immediate postoperative complications were not common. The main disadvantage is the inaccessibility of the uterus in case of postmenopausal bleeding (2 patients). Partial colpocleisis has a place in the armamentarium of the gynecologist treating isolated cases of prolapse of the uterus, and may be indicated in the elderly women with total procidentia who is a poor surgical risk an in whom general anesthesia is contraindicated, and who is certain she wants to forego sexual intercourse.

The Neugebauer-Le Fort operation: a review of 118 partial colpocleises.

The Neugebauer-Le Fort operation or partial colpocleisis is a safe, simple and rapid procedure for the repair of uterine prolapse in elderly women who are poor surgical risks. The operation was performed in 188 women with total procidentia. Good anatomic results were obtained in 90.7% of the women. Late complications were rare, including recurrence of prolapse (3 patients), and urinary incontinence (12 patients). Immediate postoperative complications were not common. The main disadvantage is the inaccessibility of the uterus in case of postmenopausal bleeding (2 patients). Partial colpocleisis has a place in the armamentarium of the gynecologist treating isolated cases of prolapse of the uterus, and may be indicated in the elderly women with total procidentia who is a poor surgical risk an in whom general anesthesia is contraindicated, and who is certain she wants to forego sexual intercourse.

The Post-Total Hysterectomy (Vault) Vesicovaginal Fistula

Sixty-seven cases of lower urinary tract genital fistulas were seen during the last 7 years. Of the 67 cases 45 (67 per cent) followed total hysterectomy, of which 43 were operated upon transvaginally using the Latzko technique of partial colpocleisis. There were 40 primary cures (93 per cent) and 3 failures (7 per cent), each of which was cured by a secondary Latzko operation. The advantages of the operation are discussed.

Post-Hysterectomy Vesicovaginal Fistula: Treatment by Partial Colpocleisis

Urologists have been reticent to approach vesicovaginal fistulas via the vaginal route. The Latzko partial colpocleisis seems to be an easier, faster and less traumatic procedure than many advocated in the literature. The success rate is high and the procedure is highly recommended.

Simplified method for transvaginal closure of vesicovaginal fistula after hysterectomy.

The application of a modified Latzko's partial colpocleisis to vesicovaginal fistula occurring after abdominal hysterectomy has been reported. The present method, which is safe and highly effective, can be perfomred with ease by urologists having little experience with transvaginal operations. It is important in performing the present operation to remove the tension on the bladder wall by dissecting the cleavage plane between the vaginal wall and the bladder wall in a distal direction from the denuded area surrounding the fistula.

Combined vaginal and transvesical approach in successful repair of vesicovaginal fistula.

The distressing problem of urinary leakage through a vesicovaginal fistula has been much discussed and numerous techniques have been presented for surgical repair. Unfortunately, many of these methods and special tricks, ranging from Sims' introduction of silver wire sutures to the more recent partial colpocleisis (Latzko), are subject to failure and only lead to greater difficulties at attempted secondary repair. The gynecologist has uniformly attacked closure of the fistula by the vaginal route and has shied away from the transvesical approach, while the urologist has reversed this and has tried to cure this abnormal opening only through a suprapubic opening. Moir states: Don't attempt a transvesical or transabdominal operation unless for a very special reason. Similarly, Falk writes: Suprapubic, extraperitoneal and transvesical and transabdominal procedures are now seldom performed by gynecologists. Also (ibid.), These transvesical methods of repair are still the ones most frequently used by urologists. The separate specialist

Vesicovaginal fistula

Of the 149 cases of fistula here recorded 120 were subjected to operation for attempted cure of the fistulas or relief of the resulting incontinence. In 27 of the patients in the carcinoma-irradiation group no operation was done because of advanced carcinoma. In one patient in the miscellaneous group a spontaneous fistula healed spontaneously, and in another no operation was done because of severe and eventually fatal urosepsis. Of the 120 treated patients the fistula was cured in 108 and the incontinence was relieved by ureterointestinal anastomosis in 3 others, 2 from the irradiation group, leaving 9 with final failure. Five of these were from the carcinoma-irradiation group, so that in the 99 treated cases falling in the other groups there was 96 per cent eventual success. In 14 of these patients 26 previous unsuccessful attempts at correction of the condition had been made at the Johns Hopkins Hospital, so that success was achieved on the first attempt on our service in 82 per cent. The Latzko partial colpocleisis or some modification thereof was used 58 times with success on the first attempt in all but 2, and on the second attempt in these 2. Transabdominal approach was used only twice for fistulas which were inaccessible vaginally. The transvesical approach was not used.