Urethro vaginal reflux can produce vaginal distension that is sonographically identical to obstructive hydrocolpos and may present with day time incontinence in young girls. This may be due to dysfunctional voiding issues. Postvoid sonography allows proper diagnosis and it can be treated by early clinical suspicion, proper diagnosis and advice.

1. Urethro vaginal reflux - A case report

2. a p o l l o m e d i c i n e xxx ( 2 0 1 4 ) 1e4
Available online at www.sciencedirect.com
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Case Report
Urethro vaginal reflux e A case report*
Suryakant Choubey, Nagendra Tripathy*, Pavan K.V., A. Nagaraj Rao,
A. Mohan
St.John's Medical College, Koramangala, Bangalore, Karnataka 560034, India
a r t i c l e i n f o
Article history:
Received 12 December 2013
Accepted 30 July 2014
Available online xxx
Keywords:
Day time incontinence
Paediatric incontinence
Urethro vaginal reflux
Post micturition dribbling
a b s t r a c t
Objective: The purpose of this study was to describe a case of day time incontinence due to
Urethro vaginal reflux.
Methods: This is a case report of a 18 yr old girl who had presented to the out patient
department with day time incontinence and post void dribbling. Ultrasound suggested an
urethral diverticulum but the actual diagnosis was arrived by performing a MCU which is
suggestive of a Urethro Vaginal reflux.
Results: She improved significantly by proper toilet training and is predominantly dry at 1 yr
follow-up.
Conclusions: Urethro vaginal reflux can produce vaginal distension that is sonographically
identical to obstructive hydrocolpos and may present with day time incontinence in young
girls. This may be due to dysfunctional voiding issues. Postvoid sonography allows proper
diagnosis and it can be treated by early clinical suspicion, proper diagnosis and advice.
Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Urethro Vaginal reflux is a condition where the voided urine
refluxes into the vagina due to anatomical or pathological
causes.1
It is known to be a cause of incontinence in the paediatric
age group.
Hydrocolpos is Commonly due to an anatomical obstruc-tion
like Imperforate hymen, Vaginal septum or Hypoplastic
vagina.
Gross distention of the vagina due to refluxed urine has
been rarely described.
Wereport one such rare case of adult urethro vaginal reflux
with classical manifestations.
2. Case report
2.1. History
A 18 yr old young unmarried girl presented to the outpatient
department with complaints of day time incontinence of
urine. She is predominantly dry at night time.
She had no other urological complaints. Her
Menstrual cycles were regular and normal. There was no h/o
Neurological/Psychiatric illness. No h/o Trauma/
Instrumentation.
2.2. Examination
Abdominal, genital and rectal examination e Unremarkable.
* Presented as a poster in SZ-Usicon 2013 held in Mysore.
* Corresponding author. Office of Dept of Urology, In-patient Block, St.John's Medical College, Koramangala, Bangalore, Karnataka
560034, India.
E-mail address: tripathy9@yahoo.com (N. Tripathy).
http://dx.doi.org/10.1016/j.apme.2014.07.016
0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
Please cite this article in press as: Choubey S, et al., Urethro vaginal reflux e A case report, Apollo Medicine (2014), http://
dx.doi.org/10.1016/j.apme.2014.07.016

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Fig. 1 e Contrast filled Urinary bladder just before the Micturating Cysto Urethrogram to rule out any fistula.
2.3. Investigations
Complete Haemogram e Normal, RBS e 111, S.Creatinine e
0.8, Electrolytes e Normal, Urine routine e 8e10 WBC,
Urine C/s e No growth.
UFR e voided volume e 369 ml,max flow e 26.8, Avg flow e
17.8, PVR e 16 ml.
Ultrasound abdomen e Normal Kidneys and Upper tracts,
Urinary bladder e Normal, Hydrocolpos þ
Voiding cystourethrography e
Filling phase e Normal, No extravasation (Fig. 1).
Early voiding phase e progressive gross distention of the
vagina due to retrograde filling as the bladder emptied
(Fig. 2).
Late voiding phase e progressive complete evacuation of
the vagina. No vesicoureteral reflux (VUR) was seen
bilaterally.
2.4. Management
Instructions on proper voiding form a key element in the
management of UVR.
Toilet training:
, Sit steadily on the toilet brim, legs fully supported.
Fig. 2 e MCU film demonstrating Filling of vagina with contrast.
Please cite this article in press as: Choubey S, et al., Urethro vaginal reflux e A case report, Apollo Medicine (2014), http://
dx.doi.org/10.1016/j.apme.2014.07.016

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Fig. 3 e CT KUB showing distension of vagina with contrast.
, Keep the legs well apart.
, Lean the trunk forward (as much as you can) making
the pelvis tilt forward and the urinary stream more
vertical.
, Separate the labia before voiding.1
, At the end of voiding, use the toilet paper to press and
lift the perineum forward/upward (from the base of the
vagina and away from the rectum) to empty urine from
the vagina.
The patient got completely cured with this simple
advice.
Fig. 4 e CT reconstruction showing contrast in both bladder and vagina without any fistula.
Please cite this article in press as: Choubey S, et al., Urethro vaginal reflux e A case report, Apollo Medicine (2014), http://
dx.doi.org/10.1016/j.apme.2014.07.016

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3. Discussion
Urethro Vaginal Reflux Causes retrograde filling of the vagina
during micturition causing Hydrocolpos2 and post void in-continence
of urine. It can occur in both supine and the up-right
positions.
It is Common in pre pubertal girls; But may also be seen in
post pubertal girls and women.
Hydrocolpos can be complete, partial or minimal. Gross
distension is relatively uncommon.
3.1. Aetiology
, A relatively horizontal vagina in the prepubertal age,
, Tightly apposed labia in obese subjects,3
, Labia minora adhesions,3,4
, Hypospadias and
, Spastic pelvic floor muscles5 (as in cerebral palsy)
3.2. Presentation
, Urinary incontinence3
, Recurrent UTI1
, Bed wetting3
, Vulvo-vaginitis1
, Irritation of the genitalia
, Foul smell and
, Vaginal discharge
The UTI may be real or due to contamination of urine by
the vaginal flora.1,6,7 The urogenital tract anatomy is usually
normal for age.
3.3. Management
Instructions on proper voiding form a key element in the
management of UVR.3 With proper assistance, the condition
can be entirely cured by non pharmacological and non surgi-cal
methods.3
4. Conclusion
Vesicovaginal reflux can produce vaginal distension that is
sonographically identical to obstructive hydrocolpos and may
present with day time incontinence in young girls. Postvoid
sonography allows proper diagnosis and it can be treated by
early clinical suspicion, proper diagnosis and advice. Even
though it most commonly occurs in young girls, the urologist
should consider it as a differential diagnosis in older girls and
women with incontinence as it may present late in the adult
hood (Figs. 1e4).
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
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Nonobstructive hydrocolpos: sonographic appearance and
differential diagnosis. Radiology. 1983;149:273e278.
3. Stannard MW, Lebowitz RL. Urography in the child who wets.
AJR Am J Roentgenol. 1978;130:959e962.
4. Capraro V, Greenberg H. Adhesions of the labia minora: a study
of 50 patients. Obstet Gynecol. 1972;39:65e69.
5. Saxton H, Borzyskowski M, Mundy A, Vivian G. Spinning top
urethra: not a normal variant. Radiology. 1988;168:147e150.
6. Kelalis P, Burke E, Stickler G, Hartman G. Urinary vaginal reflux
in children. Pediatrics. 1973;51:941e943.
7. Butcher C, Donnai D. Vaginal reflux and enuresis. Br J Urol.
1972;45:501e502.
Please cite this article in press as: Choubey S, et al., Urethro vaginal reflux e A case report, Apollo Medicine (2014), http://
dx.doi.org/10.1016/j.apme.2014.07.016

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