Urethrovaginal reflux--a common cause of daytime incontinence in girls.
OBJECTIVE
The objective of this study was to estimate the frequency of urethrovaginal reflux as the cause of daytime incontinence in school-age girls, and to study the characteristic symptoms and the effect of simple instructions intended to amend the problem.


METHODS
Girls with urethrovaginal reflux were identified in a group of 169 girls, aged 7 to 15 years, referred to a specialist clinic because of daytime incontinence. They were evaluated by a noninvasive screening protocol, including a careful history and neurourologic examination, bladder diaries, urine analysis, uroflows, and residual urine determined by ultrasound. Girls with urethrovaginal reflux were instructed by a urotherapist on how to achieve better toilet habits.


RESULTS
Urethrovaginal reflux was found in 21 (12.4%) of 169 girls as the sole (19) or contributing (2) cause of their daytime urinary incontinence. They all had a typical history of small leakage 5 to 10 minutes after voidings during the day, confirmed by a specific bladder diary. All were neurologically healthy, and all but 2 had a normal bladder function. The latter 2 girls had residual urine and asymptomatic bacteriuria. At follow-up after median 2 years, all girls were free from postmicturition leakage, but the 2 with residual urine remained daytime incontinent with cystometrically proven phasic detrusor overactivity.


CONCLUSIONS
Urethrovaginal reflux is a common cause of urinary incontinence in girls. The diagnosis is easily obtained by an adequate history, completed with a specific bladder diary. The problem is easily resolved by proper voiding instructions.
Mattsson
Sven
S
Division of Pediatrics, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping, Sweden. sven.mattsson@lio.se
Gladh
Gunilla
G
D000293:Adolescent; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D014515:Ureteral Diseases / Q000175:diagnosis / Q000453:epidemiology*; D014549:Urinary Incontinence / Q000453:epidemiology*; D014623:Vaginal Diseases / Q000175:diagnosis / Q000453:epidemiology*