Vesico-Vaginal Reflux – A Less Recognised Entity
Journal Title: Indian Journal of Applied Radiology - Year 2018, Vol 4, Issue 1
Abstract
Vesicovaginal Reflux (VVR) is a rarely encountered and less known entity among paediatricians and radiologists. It is a functional voiding disorder, usually seen in pre-pubertal girls without anatomical or neurological abnormality and is defined as abnormal retrograde reflux of urine into vaginal vault during bladder distension and early micturition. It presents with vaginal collection sonographically identical to obstructive hydrocolpos. It is important to differentiate these two, as the treatment of VVR is mainly non-surgical. Aims and objectives: The purpose of this study was to describe a series of cases of adolescent girls presenting with various genitourinary symptoms where sonography showed a vaginal collection similar to hydrocolpos, later proved to be due to VVR. The protocol for diagnosis and findings of VVR are reviewed based on multiple imaging modalities (Table 1). Materials and Methods: With the informed consent by patients, 200 girls aged between 8-18 years having recurrent genitourinary symptoms were examined and sonographically imaged. Of these, 5 children who had sonologically detectable vaginal collection were evaluated in full bladder status and postvoid status. Few additional investigations like IVU, MCU, CT urography and MRI were done to rule out anatomical abnormalities of the genitourinary tract. Results: Findings common to these was a well defined ovoid vaginal collection identified in full bladder that disappeared after complete voiding. Additional imaging modalities ruled out anatomic abnormalities of the genitourinary tract. Conclusion: Vesicovaginal reflux can produce vaginal collection that is sonographically identical to obstructive hydrocolpos. It is important to differentiate this functional disorder presenting as hydrocolpos from other obstructive causes of hydrocolpos which require surgical management. Sonographic examination in distended bladder followed by a postvoid evaluation easily provides the correct diagnosis of VVR by demonstrating disappearance of the vaginal collection. Management includes behavioural modifications, toilet training and parental education.
Authors and Affiliations
Kulkarni AM
Keywords
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