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Pediatric urethrovaginal reflux: an underestimated cause of urinary incontinence and its successful management
Vinod Kumar Prabhuswamy1, Venkatesh Krishnamoorthy2, Prasanna Matippa2
1NU Hospitals (South), 6, 15th main, 11th cross, Padmanabhanagar, Bangalore, 560070, Karnataka, India. vinodkumarbmc144@gmail.com.
Insights
Urethrovaginal reflux (UVR) is a common cause of daytime urinary leakage in girls. Early diagnosis through detailed history and behavioral therapy can effectively treat this condition.
Area of Science:
- Pediatric Urology
- Female Lower Urinary Tract Dysfunction
Background:
- Urethrovaginal reflux (UVR), caused by vaginal urine entrapment, is an underdiagnosed cause of daytime urinary incontinence in toilet-trained girls.
- This condition often goes unnoticed due to a lack of specific symptom reporting by patients or parents.
Purpose of the Study:
- To highlight urethrovaginal reflux as a significant cause of urinary incontinence in girls.
- To identify predisposing factors, facilitate early detection, and outline treatment strategies for UVR.
Main Methods:
- A cohort of 25 girls (9-14 years) with mixed daytime urinary incontinence underwent detailed history, physical examination, bladder diaries, and urodynamic assessments.
- Micturating cystourethrography was employed for cases unresponsive to conservative management.
Main Results:
- Urethrovaginal reflux was diagnosed in 6 out of 25 girls (24%), presenting with post-micturition dribble.
- Conservative management including behavioral modifications and urotherapy was implemented.
- All diagnosed girls achieved complete resolution of urinary incontinence after 12 months of follow-up.
Conclusions:
- Urethrovaginal reflux must be considered in the differential diagnosis of daytime urinary incontinence in girls.
- A thorough and detailed patient history is crucial for accurate diagnosis.
- Effective management typically involves appropriate voiding instructions and behavioral therapy.
Introduction And Hypothesis:
Urethrovaginal reflux (UVR) secondary to vaginal urine entrapment is an unnoticed cause of daytime urinary leakage in toilet-trained girls. Our aim is to emphasize the diagnosis of UVR as a cause of urinary incontinence, its predisposing factors, early detection, and treatment.
Methods:
A total of 25 girls aged between 9 and 14 years presented with mixed daytime urinary incontinence from 2019 to 2021. They were evaluated by detailed history, vaginal examination, focused neurological examination, bladder diaries, urine analysis, uroflowmetry, and residual urine assessment. Micturating cystourethrography was also performed in those girls who did not show improvement with a conservative line of management.
Results:
The parents of these girls were educated about the cause of leakage. They were treated with behavioral modifications, urotherapy, correcting toilet postures, and reverse sitting on the commode. Urethrovaginal reflux was found in 6 of the 25 girls (24%). Their ages were 9, 10, 10, 11, 12, and 14 years respectively. Two girls (10 and 14 years old) had a body mass index more than 25. They all had a typical history of a small quantity of urine leakage 5-10 min (post-micturition dribble) after every void. At follow-up after 12 months, all of them were free from urinary incontinence.
Conclusions:
Urethrovaginal reflux should be considered in the differential diagnoses of girls with day-time incontinence. The key to diagnosis is an appropriate and detailed history as it is common for parents or girls to ignore symptoms or fail to report them. Proper voiding instructions and behavioral therapy often resolve the problem.
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