Vesicovaginal fistula diagnosis and repair, Benghazi, Libya (nine years of of experience)

Introduction: Although most of vesicovaginal fistulas (VVF) are iatrogenic, they can also occur as a result of congenital anomalies, neoplastic changes, and complications of radiotherapy. In rural areas, the obstructed labor may lead to the development of VVF. However, the most common cause of VVF in developed areas is iatrogenic damage of the bladder tissue.Aim: To confirm that the immediate repair of iatrogenic urinary bladder injures during obstetric or gynecological surgeries prevents VVF formation, and to identify optimal time and outcome of surgical techniques of VVF repair.Patients & Methods: Prospective study was carried over 9 years and included 95 patients. These patients were divided into two groups; one group underwent immediate intra-operative repair of urinary bladder injuries (n=76), while other group presented with VVF and underwent either reconstructive or urinary diversion surgeries on elective bases (n=19).Results: The mean age of 19 cases having VVF was 29.4 ± 8.4 years. One case was missed and other 18 cases underwent abdominal repair (n=8), vaginal repair (n=5) and permanent urinary diversion (n=5). The time of repair ranged from 2 day to 7 months after detection of VVF. The success rate of post-surgical VVF repair was 92.3%.Conclusion: Immediate repair of urinary bladder injuries during obstetric or gynecological surgeries prevents development of VVF. Post-surgical VVF repair can be done in first post-operative days before inflammatory changes takes place. The result of VVF repair depends on the experience of the surgeon rather than the used surgical techniques

"Gunshot injury to the pelvis".The bullet voided through the urethra

Gunshot injuries (GSIs) are considered as an emergency and life threatening. The gunshots injuries to the urinary tract are uncommon. The high-velocity of bullet can cause both a penetrating injury to the target organs as well as blast injury to nearby structures, in addition to thermal injuries. In most of the cases, laparotomy is required to remove the bullet and to repair the injuries. The phenomenon of spontaneous migration of retained bullet to different parts of body has been described in the medical literature. Here, we present a patient who sustained penetrating GSI to the pelvis, without organ injuries, including the bladder. The bullet initially was retained within peri-vesical fat and the bladder wall while the mucosa remained intact, then it migrated into the bladder and came out through the urethra during voiding on the sixth day after injury