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The presentation of two unusual cases of pelvic actinomycosis.Case reports.Department of Obstetrics and Gynecology, Hospital Kladno.The observation of two cases of pelvic actinomycosis. These cases were complicated by the abdominal wall fistula in one case and vaginal fistula in the other.Actinomycosis is a chronic disease with tendency to progress per continuitatem into neighbouring tissues and with tendency to formation of fistulas. Two less common localisations of progress of the disease are described; it means the abdominal wall and vagina. In spite of a more advanced stadium, if adequately treated, a recovery ad integrum is common.

The authors discuss treatment of vesicovaginal fistulae (VVF) in 36 patients and in six patients urethrovaginal fistulae treated in 1989-1995. The most frequent cause of VVF were iatrogenic lesions after hysterectomy. Occlusion of the fistula was performed 12x by the transvesical approach, nine times by a combined transperitoneal and vaginal approach, four times by a transvesical and transperitoneal approach, eight times by the vaginal route only and three times the authors had to make a continent derivation of urine of the sigma-rectum "pouch" type. Continence by primary operation was achieved in 86%, in urethrovaginal fistulae one reoperation was necessary. With the development of radical operations in the lesser pelvis in women the incidence of iatrogenic lesions is rising slightly, however when the technique of minimal invasive reconstruction urology is used, the prognosis of occlusion of fistulae is favourable.

Insertion of IUDs with strings has been common, as the strings make checking for the presence of the IUD and its later extraction easier. A slight increase of the failure rate and expulsion rate over IUDs without strings has been noted. Women sometimes ask to have the IUD string shortened, because it interferes in intercourse. If this is done, the IUD must later be located by palpating it. String shortening is also unfavorable because during involuntary uterine contraceptions, the end of the string may become lodged in a cervical crypt and form a fistula. Longer strings don't guarantee protection from laqueatic fistulae. The author has observed 5 cases where the fistulae have occurred though the IUD had long strings. In these cases, the IUD is removed with an extractor of the type used with the IUD Dana and Super Dana. It seems unlikely that improper IUD insertion was responsible for these fistulae, because no insertion was accompanied by pain and bleeding, which would be expected if a string pierced and lodged itself in a cervical crypt. An encrypted IUD string has never been found in the first control visit, 1 month after insertion. Rather, it has always been found months or years after IUD insertion. The incidence of the complication may be due to the rigidity of the strings used in IUD manufacture. The manufacture of IUDs with more pliable strings may reduce the risk of laqueatic fistulae.