Massive intravaginal lithogenesis following repeated Latzko's repair of recurrent vesicovaginal fistulas

Surgical strategies for closure of vesico-vaginal fistulas remain a controversial issue. Latzko's repair technique is commonly used by gynaecologists. We report on our experience with surgical therapy of vesico-vaginal fistulas in 61 women from 1959 to 1995. Latzko's repair was performed in 43 women leading to primary success without recurrence in almost all patients (41 of 43). We have therefore demonstrated the feasibility of this approach. However, complications may occur in selected patients. We report on a woman with profound vaginal shortening, formation of an extensive vaginal cavity, and subsequent massive intravaginal lithogenesis following Latzko's repair and reoperation due to recurrent fistulas. The occurrence of ''vaginal stones'' underlines both the limits and complications of the high colpocleisis used in Latzko's technique, particularly if performed repeatedly. Relapses are usually increased in magnitude and are characterised by abundant surrounding scar tissue formation and limited blood supply. As illustrated in our case report, these factors limit considerably the successful outcome of a secondary Latzko operation, resulting in an increased risk of complications. From the urological point of view, relapses of vesico-vaginal fistulas should be supplied transperitoneally with interpositions aiming at preventing vaginal shortening.