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PURPOSE: The aim of this study is to compare anatomy pathological lesions seeing in urogenital fistula in Cocody Teaching Hospital between two decades, 1990 to 2000 and 2000 to 2010. MATERIEL AND METHOD: This survey is retrospective and carries on 20 years (January 1990 to December 2011) 190 urogenital fistulas (140 cases between 1990 and 1999; 50 from 2000 to 2011) hospitalized in our unity. Anatomy clinical characteristics of these fistulas were determined by clinical or paraclinical examination. RESULTS: Between 1990 and 1999, fistulas were classified in 20 bladder-uterine fistulas (14.29%), 16 uretro-vaginal fistulas (11.43%) and 104 bladder-vaginal fistulas (74.29%) of whom 80 isolated UGFs and 24 UGFs associated with recto-vaginal fistula. These 104 UGFs were located at: bladder neck 22 cases (21.15%), bladder trigonal 46 cases (44.23%), urethra 14 cases (13.46%). Twenty-two bladder sphincter were destroyed and represented 21.15% of fistula's bladder-vaginal fistula and 15.71% of all UGFs. The average fistula diameter was 3 cm [extremes: 1 and 12 cm]. In 22 cases (15.71%), fistula diameter was more than 10 cm. It was bladder neck and sphincter destruction. Hundred and twenty-six fistulas were isolated (90%). Only 10% (14 cases) were associated. Fistulas were primitive in 85.71% of cases (120/140), recurrent in 7 cases (7.86%) and multi-recurrent (>3 reinterventions) in 9 cases (6.43%). From 2001 to 2011, no bladder-uterine fistulas were seen, but: 6 (13.95%) isolated uretero-vaginal fistulas and 6 (13.95%) uretero-vaginal fistulas associated with bladder-vaginal fistula, 31 (62%) bladder-vaginal fistulas of whom 20 (64.52%) bladder trigonal fistulas, 6 (19.34%) retro-trigonal fistulas and 2 (6.45%) urethral fistulas. Only three (9,68%) recto-vaginal fistulas were associated. The average fistula diameter was 2 cm. The fistulas were isolated in 40 cases (80%) and associated (VVF+uretero vaginal F) in 10 cases (20%). Thirty-five cases (70%) were primitive and 10 cases (20%) recurrent of whom 5 (10%) many recurrent. Fistulas were classified in simple fistula in 7 cases (14%) and complex fistula in 43 cases (86%) CONCLUSION: UGF remained relatively frequent in Cocody Teaching Hospital, but the lesions have favorably evolved in the last decade. Simple type of fistula became more frequent than complex ones. LEVEL OF EVIDENCE: 4.

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BACKGROUND: Uterine inversion is an uncommon complication in the non-puerperal period. Submucosal myoma is more frequently involved usually among women above 45 years old. CASE PRESENTATION: A 28 year-old patient was admitted to the gynaecology emergency room in Cocody Teaching Hospital, Abidjan, Cote D'Ivoire with a large lobulated fleshy mass in the vulval area. She had been having pelvic pain, heaviness in the pelvis and bleeding per vaginam intermittently for 6 months for which she had been treated conservatively without improvement. The clinical examination was consistent with uterine inversion secondary to a mass in the fundus of the uterus. The uterus with the mass in the fundus was excised by a combined vaginal and abdominal (abdominal hysterectomy) approach. Histopathology confirmed the mass to be a sub-mucosal uterine leiomyoma. She has been followed up for 12 months without complaints. CONCLUSION: We have presented a young woman with an unusual non-puerperal, total and chronic uterine inversion as a result of uterine leiomyoma managed successfully by a combined abdominal and vaginal approach.