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Imaging Studies VI: Voiding Cystourethrography and Cystography01:22

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[Vesicovaginal Reflux and Urocolpos].

María Fernández-Ibieta1, Irene Martínez-Castaño1, María José Guirao-Piñera1

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Summary

Vesico-vaginal reflux (VVR) is a condition where urine flows back into the vagina during urination, often causing daytime leaks in young girls. Behavioral modifications and proper voiding techniques are effective treatments for VVR.

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Area of Science:

  • Pediatric Urology
  • Female Lower Urinary Tract Disorders

Background:

  • Vesico-vaginal reflux (VVR) is the retrograde flow of urine into the vaginal vault during micturition.
  • It is occasionally observed in pre-adolescent girls, typically presenting as post-voiding dribbling.
  • Significant urocolpos, or vaginal distension with urine, can occur.

Observation:

  • This report details three cases of VVR in pre-adolescent girls presenting with diurnal urinary incontinence.
  • Voiding cystourethrograms (VCUG) confirmed VVR and urocolpos in all cases.
  • One patient had a history of treated vesicoureteral reflux (VUR).

Findings:

  • Two cases were successfully managed with behavioral modifications, including voiding re-education.
  • One case experienced recurrence due to non-adherence to therapy, highlighting the importance of consistent management.
  • VVR is found in 12-15% of girls referred for urinary incontinence.

Implications:

  • VVR often occurs in the absence of anatomical obstruction, linked to voiding mechanics like leg crossing.
  • Proper voiding instructions are crucial for VVR management.
  • Behavioral modifications, including altered voiding posture, can effectively resolve VVR.