Traditional vaginal cauterization is practiced in some low-resource settings, including Somalia, for gynecological complaints. Unregulated thermal exposure may cause severe tissue destruction. Circumferential full-thickness vaginal necrosis requiring reconstruction is extremely rare. A 70-year-old multiparous Somali woman presented with severe vaginal pain, foul discharge, fever, and urinary retention 14 days after cauterization. Examination revealed stage IV pelvic organ prolapse and circumferential full-thickness vaginal necrosis extending to within 1 cm of the urethral meatus. Laboratory tests showed leukocytosis (12 400/mm3), elevated C-reactive protein (46 mg/L), and creatinine 1.3 mg/dL. Intravenous antibiotics were initiated. Wound culture grew Klebsiella spp. susceptible to gentamicin, and therapy was adjusted. Surgical debridement followed by colpocleisis was performed. Recovery was uneventful. Traditional vaginal cauterization may cause devastating thermal injury requiring radical surgery. Early recognition and multidisciplinary management are essential. Preventive public health measures are urgently needed.

Vulvar cancer is a rare gynecologic malignancy with a higher incidence in postmenopausal women. Squamous cell carcinoma is the most common histologic subtype (>90% of cases). The majority of affected patients are symptomatic and present with vulvar pruritus, bloody discharge, pain, and/or a palpable mass. The disease is staged by using the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was most recently revised in 2021. The characteristic pattern of local vulvar cancer spread involves infiltrative tumor extension to the urethra, anorectum, vagina, and urinary bladder (less commonly). Lymphatic spread is the primary route of metastasis and a critical prognostic factor. The authors review the vulvar anatomy, as well as the pathogenesis, routes of spread, and key imaging findings of vulvar malignancy. In addition, the roles of multiple imaging modalities including lymphoscintigraphy, MRI, fluorine 18-fluorodeoxyglucose PET/CT, and PET/MRI in diagnosing vulvar cancer and acquiring the information needed for accurate staging, treatment planning, determining the prognosis, and assessing treatment response are outlined. ©RSNA, 2026 Supplemental material is available for this article.

The case of a 65-year-old woman with a complication 15 years after mesh repair of vaginal prolapse is presented. The patient presented with chronic pelvic pain, recurrent urinary tract infections (UTIs), foul-smelling vaginal discharge, and urinary frequency/urgency for the previous eight years. Magnetic resonance imaging led to the diagnosis of vaginal mesh erosion and a urethral diverticular calculus secondary to urethral mesh erosion. Transvaginal removal of the mesh erosion was performed with simultaneous exploration of the urethral diverticulum, removal of a urethral stone, and urethral reconstruction using a multi-layer approach. Three months later she was symptom-free and continent. This case adds to the limited literature on urethral diverticulum with calculi secondary to mesh erosion, and highlights the need for long-term follow-up and clinician awareness of this rare, delayed complication.

Background/Objectives: Postoperative urinary retention (POUR) occurs in 10-15% of women after surgical procedures for stress urinary incontinence (SUI). Guarding Reflex Inhibition Training (GRIT) is a novel behavioral approach that teaches patients to consciously inhibit involuntary pelvic floor contraction. We evaluated whether preoperative GRIT is associated with decreased POUR after urethral bulking with polyacrylamide hydrogel (PAHG). Methods: We performed a retrospective review of 145 women with SUI. Perioperative care was consistent across groups, separated by date of service; only those treated after November 2023 received structured GRIT instruction. The primary outcome was POUR, defined as the need for >1 episode of straight catheterization or discharge with a catheter. Results: POUR occurred in 15/106 (14.2%) patients without GRIT and 0/39 (0%) patients with GRIT. This difference was statistically significant (Fisher's exact test p = 0.012), corresponding to an absolute risk reduction of 14.2% (95% CI: 4.8-23.9) and a number needed to treat (NNT) of 7. Post hoc power was >90%. Conclusions: Preoperative GRIT, a novel and reproducible training paradigm, was associated with a reduction in POUR following urethral bulking. By targeting conscious inhibition of the guarding reflex, GRIT highlights the potential for integrating behavioral retraining with procedural therapy across incontinence interventions.

A retrospective cross-sectional description was conducted to investigate co-infection rates of Neisseria gonorrhoeae (Gonorrhea) and Chlamydia trachomatis (Chlamydia) in patients from Northern Vietnam who visited the Central Dermatology Hospital during 2016-2019 and the factors including gender, age, location, and season that may relate to the co-infection rates. Data of hospital routine diagnostics using rapid tests for chlamydia and Gram staining for gonorrhea for patients with vaginal or urethral discharge syndrome were analysed. Real-time PCR was used to confirm the positive samples. During the 4 year study period, 5937 (0.74%) cases of either mono- or co-infections of gonorrhea and chlamydia were detected among 795,599 visiting patients. Of these cases, 2427 (41.36%) were diagnosed with gonorrhea, 3474 (57.99%) with chlamydia, and 36 (0.65%) with co-infections of gonorrhea and chlamydia. The co-infection rate in women was 4.8-fold higher than that in men (p < 0.0001), and in Hanoi capital, it was 2.3-fold higher than in all other regions in Northern Vietnam (p = 0.018). In terms of seasonality, the highest and lowest co-infection rates were observed in summer (33.33%) and winter (19.41%), respectively. In conclusion, the prevalence of gonorrhea and chlamydia co-infections was comparatively low, with a predominance in women as compared to men, in Hanoi capital than in the remaining areas of Northern Vietnam. Additionally, a higher frequency was observed during the summer season. The data obtained is important in controlling the rate of gonorrhea and chlamydia in Vietnam and contributes valuable insights to the global and Asian epidemic mapping of these infections.

A 58-year-old female presented with a 6-month history of recurrent "worms" found in her toilet, which she suspected originated from her urinary tract. Physical examination was unremarkable. Laboratory analysis revealed motile, blood-red worm-like organisms measuring 25-35 mm in length, initially suspected to be Dioctophyma renale larvae. However, parasitic screening tests were negative, and microscopic examination identified setae characteristic of oligochaetes. Further investigation revealed these organisms only appeared in the first-floor toilet. Subsequent sterile urine collection showed no recurrence, confirming environmental earthworm contamination rather than true parasitosis. This case highlights the importance of morphological evaluation and proper specimen collection in differentiating parasitic infections from environmental contaminants.

Sexually transmitted infections (STIs) present significant public health challenges in resource-limited settings where syndromic management, which often leads to misdiagnosis and over-treatment, remains standard care. We retrospectively evaluated hypothetical STI risk assessment-only (Triage-only) and sequential risk assessment plus STI diagnostic testing (Triage&Test) approaches as potential enhancements to syndromic management in a high-burden setting. A retrospective analysis was conducted using historic data from a cross-sectional study of adults (≥ 18 years) accessing six outpatient care sites in Eswatini between July 2022 and April 2023. Clinical records included STI risk factor assessments, outcomes of syndromic assessment for vaginal discharge syndrome (VDS) and male urethritis syndrome (MUS), leukocyte esterase (LE) and HIV testing, and molecular-based testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Sex-specific predictive risk scores (PRS) tools for CT/NG/TV infections were developed using LASSO penalized logistic regression. Subsequently, the diagnostic performance of various hypothetical Triage-only and Triage&Test approaches was compared to molecular-based testing for CT/NG/TV infections. The aim was to identify strategies meeting programmatic benchmarks of ≥ 90% sensitivity and < 60% testing efficiency. Of 1396 participant records analysed, 65.4% (n = 913) were women and the median age was 29 years (IQR 23-36). Triage-only approaches underperformed, resulting in high proportions of false-positive and false-negative cases. Specifically, VDS showed a sensitivity of only 32.9% (95% CI 27.5-38.6) and a specificity of 75.1% (95% CI 71.5-78.5), while MUS had a sensitivity of 65.0% (95% CI 57.0-72.4) and specificity of 88.0% (95% CI 84.0-91.4). All PRS tools configurations in simulated Triage&Test approaches outperformed Triage-only methods by reducing false-negative and eliminating false-positive cases, thus achieving 100% specificity and positive-predictive value. Despite these improvements, no Triage&Test approach fully met established benchmarks. The highest sensitivity, observed in men, was 91.1% (95% CI 85.5-95) with an efficiency of 86.0%. In women, the best sensitivity was 79.0% (95% CI 73.8-83.6) at an efficiency of 60.1%. While PRS tools integrated within Triage&Test approaches may improve STI diagnosis in high-burden settings, challenges in balancing accuracy and resource demands persist. Access to affordable and well-targeted point-of-care rapid diagnostic tests appears essential to improve STI care quality in resource-limited environments.

Bladder exstrophy (BE) is a rare, complex, congenital malformation predominantly observed in men. We report a case of a female infant with BE who underwent complete primary repair of BE (CPRE). After 5 weeks of appropriate medical care and nursing, the infant was discharged successfully without urinary retention, hematuria, fever, or abdominal distention. After discharge, the child was followed up via telephone. At 1.5 months post-op, the child showed no signs of urinary incontinence, hydronephrosis, or reflux. However, ultrasonography revealed an unfilled bladder. By the third month, the child voided volitionally through the urethra every 3 h. At 6 months of age, renal ultrasonography revealed an unfilled bladder. Children may undergo augmentation cystoplasty at 2 or 3 years of age. During telephone follow-ups, the parents expressed concerns regarding their child's sexual function and fertility in adulthood. Patient follow-up will be continued to determine long-term health outcomes.

Urethral calculi are an uncommon clinical finding in females due to their relatively short and wide urethra, which typically facilitates the spontaneous passage of stones without impaction. We present a unique case of a 62-year-old female with no prior medical or surgical history who developed acute urinary retention lasting seven hours. She reported suprapubic discomfort but denied fever or flank pain. Examination revealed a distended bladder, and laboratory investigations, including renal function and inflammatory markers, were normal. Computed tomography kidneys, ureter, bladder (CT KUB) revealed a markedly distended bladder, bilateral moderate hydronephrosis, and a 2.5-cm longitudinal stone within the urethra. No renal or ureteric stones were identified. A Foley catheter was inserted successfully, draining urine and relieving symptoms, and the patient was discharged with the catheter in place for follow-up. She presented a few days later after accidental dislodgement of the Foley catheter at home. Examination revealed a portion of the stone protruding from the urethral meatus. Under appropriate analgesia and sterile technique, the entire stone was successfully removed in one piece using forceps. The patient remained stable and was monitored for post-obstructive diuresis. This case illustrates a rare presentation of a large female urethral stone causing acute urinary retention and bilateral hydronephrosis. It also highlights the potential for spontaneous expulsion and the importance of considering urethral stones in female patients with urinary retention. Due to the rarity of such presentations, this case adds valuable insight to the limited literature on urethral stones in women.