Vesicovaginal Reflux: A Masquerader

Vesicovaginal reflux (VVR) is a functional disorder seen in girls and women. It may be asymptomatic or cause incontinence and dribbling symptoms. It is often associated with high body mass index (BMI) and infrequent voiding or abnormal voiding position. It is important to be aware of this entity as it can be mistaken for a vesicovaginal or urethrovaginal fistula or hydrocolpos on imaging all of which require surgical treatment. The fluid collecting in the vagina in VVR is urine which refluxes during micturition via the introitus from the urinary bladder into the vagina and can leak out later. In a typical case, urocolpos is seen as an anechoic fluid collection in the vagina during transabdominal sonography of the pelvis with a full bladder. It usually diminishes in size and can disappear when the patient is reassessed after voiding the urine completely. Knowledge of this entity in a patient with the classical body habitus is helpful in preventing an unnecessary imaging odyssey and causing anxiety to the patient. Treatment of VVR is by modification of toileting behavior and weight loss.