Vesicovaginal reflux: A case report

Abstract

Vesicovaginal reflux is a common cause of urinary incontinence in girls. A micturating cystourethrogram, which is the diagnostic investigation of choice, can demonstrate retrograde filling of the vagina during micturition and the complete emptying of the vagina at the end of micturition. Vesicovaginal reflux is a rare cause of gross hydrocolpos occurring without any anatomical obstruction. The condition may be associated with functional voiding disturbances.

Figure 1(A–D)

USG pelvis (A) shows a grossly distended fluidfilled vagina (arrow), posterior to the urinary bladder suggestive of hydrocolpos. 3D reformatted image (B) demonstrates a grossly distended, fluid-filled vagina, suggestive of hydrocolpos; the cervix (CX) is suspended at its upper end, posterior to the urinary bladder (UB). USG pelvis (C) shows a normal uterus and cervix (note the distended vagina – three horizontal arrows). Postmicturition USG (D) shows complete evacuation of the vaginal fluid (black arrow) and a urinary bladder post-void residue

Figure 2(A–B)

Intravenous urogram. AP projection (A) shows normal renal collecting systems without ureteric ectopia. Lateral projection (B) shows a contrast-filled vagina (arrow), separate and posterior to the urinary bladder (arrowhead)

Figure 3

Sagittal reformatted CT scan of the pelvis shows a contrastfilled vagina, separate and posterior to the urinary bladder, without any anomalous connection/extravasation

Figure 4(A–D)

Voiding cystourethrogram. (A) Widened bladder neck is seen (arrow). The early voiding phases (B,C) show gross distension of the vagina due to retrograde filling with progressive bladder (UB) emptying. Late voiding phase (D) shows subtotal evacuation of the vagina and a urinary bladder residue