Nonobstructive hydrocolpos due to vesicovaginal reflux: expanding the differential diagnosis

Abstract

We report the clinical details and imaging findings for a case of vesicovaginal reflux presenting as gross urocolpos in a 15-year-old female. Findings included a large fluid-filled vagina on full-bladder scan in the absence of any anatomical abnormality, which disappeared completely after micturition. It is important for radiologists to be aware of this entity as it is rarely encountered and leads to very confusing findings, which could result in an erroneous diagnosis.

Çocukluk çağında vajinal reflü: İki olgu sunumu

“…Özellikle işeme esnasında, bacakların kapalı tutulması veya çaprazlanması önemli risk faktörlerindendir (2). Çocuklarda obezite, labial yapışıklık ve üretral mea anomalileri diğer risk faktörleridir (4). Her iki olgumuzun vücut ağırlığı normaldi, genital muayenelerinde labial yapışıklık veya meatal anomali tespit edilmedi.…”

“…Ateşli İYE geçiren hastalarda sıklıkla kullanılan ISUG, işeme sırasında kontrast maddenin vajende birikimini doğrudan gösterebilir. Tanının konulamaması durumunda alternatif görüntüleme yöntemleri olan MR veya BT ürografi kullanılabilir (4). İlk olguda bu sebeple tekrarlayan İYE öyküsünden dolayı öncelikle VUR araştırılmış ve ISUG planlanmıştır.…”

Is vaginal reflux associated with urinary tract infection in female children under the age of 36 months?

“…It has been proposed that VR is a form of bladder bowel dysfunction (BBD) and, as such, would inherently be associated with a greater risk for UTI. 3) In urology and gynecology, VR is treated as a cause of voiding dysfunction, 31 32) assessed using postvoiding US to identify the extent of hydrocolpus induced by VR and to determine the best therapeutic approach to manage urinary incontinence. 10 31)…”

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“…Although adnexal cystic lesions and bladder diverticulum can mimic these features, close evaluation along with the background knowledge of this entity, it is possible to make a confident diagnosis of hydrocolpos due to VVR. [1,10] Post-void USG is essential to demonstrate the non-obstructive nature of hydrocolpos ruling out imperforate hymen and vaginal septum atresia. VVR can be diagnosed easily on a VCUG which demonstrates direct filling of the vagina during micturition and resolves on post-void images.…”

“…CT helps in ruling out ectopic ureteric opening better than MRI, whereas MRI is the modality of choice in diagnosing uterovaginal anomalies. [4,10,12] Treatment is directed at toilet retraining and behavioral therapy to decrease the episodes of VVR. [13] Often, there are underlying urinary and genital infections which need to be treated with appropriate antibiotics.…”