Reviewer’s report
Title: 
Recurrent urethral obstruction secondary to large vulval inclusion cyst: a
remote complication of female genital mutilation: a case report
Version: 
0 
Date: 
23 May 2023
Reviewer's report:
General: The authors reported on an interesting rare complication of FGM. The
manuscript needs language editing. Authors should give plausible explanations
for patient's clinical findings. Conclusion should be made within the scope of the
finding of this case report
1. conclusion in the abstract section is not well supported by the study findings.
2. Background profoundly lacks information on the medical complication that
the patient had (urinary complications of post circumcision inclusion cysts )
3. the 1st statement of the discussion section ; 'To our knowledge this is the first
report presents urine retention as remote
complication of FGM/C in the literature" NEEDS TO BE REVISED
CONFORMING TO THE EXISTING LITERATURE DATA. There are a
number of case reports of urinary obstructions secondary to complications of
FGM.
4. Discussion line 37 and 38: needs language editing ".....lows into the urethra to
be expelled from the body "
5. It is anatomically difficult to comprehend a vulvar mass leading to bladder out
let obstruction. The bladder out let is the junction between the bladder and the
1st few cms of the proximal urethra. Hence for any mass to cause BOO it should
somehow be located in the anterior vaginal wall or it is a vulvar mass it should
extend into the vaginal canal. The final plausible explanation is the woman
having cystocele and the BOO being drawn down to the lower vagina or introitus
and compressed by the vulvar mass.
6. Better to write the discussion and conclusion sections separately. 
7. Such broad conclusion could 
not be made from this single case report 
8. would have been better to include post operative pictures of the vulva
(operation site)
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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