Vesicovaginal reflux: recognition and diagnosis using ultrasound.
BACKGROUND
Vaginal reflux is a functional voiding disorder seen in prepubertal girls without anatomical or neurological abnormality. When not associated with urinary tract infections (UTI), asymptomatic bacteriuria, post-void dribbling or daytime enuresis it may be considered a normal finding.


OBJECTIVE
To review the radiographic features of vesicovaginal reflux based on multiple imaging modalities.


METHODS
Three girls aged 11, 13 and 5 years were referred for pelvic US for daytime incontinence, post-void dribbling, frequency and urgency. One girl also had recurrent UTIs treated with antibiotics and was investigated for vesicoureteric reflux with US and voiding cystourethrogram (VCUG). All three were examined with MRI.


RESULTS
Imaging appearance common to all three girls was a fluid-filled mass posterior to the bladder that disappeared after voiding. A previous VCUG in one girl had shown contrast medium refluxing into the vagina which disappeared after bladder emptying. Pelvic MRI confirmed the findings in all three girls.


CONCLUSIONS
US examination of a distended bladder followed by a post-void study easily provides the correct diagnosis of vesicovaginal reflux by identifying the vagina as the fluid-filled mass. Treatment involves behavioural modifications. Though well known to urologists, this may be a perplexing pathology for the inexperienced trainee radiologist.
Department of Radiology, Haydarpasa Numune Egitim ve Arastirma Hastanesi, Atifbey Sok Camlik Sitesi 51/6 Altunizade, Istanbul, 34662, Turkey. gamze@kilicoglu.nom.tr
Gamze
G
Kilicoglu
Ahmet R
AR
Aslan
Metin
M
Oztürk
Ihsan M
IM
Karaman
Masum M
MM
Simsek
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*; D014555:Urination Disorders / Q000000981:diagnostic imaging*