Urethro‐vaginal reflux during micturition: An underestimated cause of urinary incontinence in adult women

Abstract

Aims: To evaluate if urethrovaginal reflux (UVR) is an underestimated cause of insensible or postmicturition incontinence in adult women. Methods: An observational and retrospective study was carried out on the computerized records of a neuro-urology department. Female patients who had insensible or postmicturition incontinence were investigated. Retrograde and voiding urethrocystography (UCG), urodynamic evaluation, urethral pressure profilometry, and anamnestic and clinical examination had to be available. Results: Among the 79 adult female patients with insensible or postmicturition incontinence in whom the whole set of required evaluations was achieved, 16 had a UVR (mean age 47 ± 15 years). There were no urethral diverticula, urethrocele, vesicovaginal, or urethrovaginal fistula on their UCG. All of them also had a cystoscopy and a CT urography which did not establish any abnormality.Conclusions: UVR is not an exclusive pathology of children. This mechanism seems to be an underestimated cause of urinary incontinence in adult women.Retrograde and voiding UCG appears to be the gold standard to confirm the intravaginal reflux. urethra, urinary incontinence, urinary tract, urography, vaginal diseases This study was approved by the local ethics committee (Comité de Protection des Personnes Ile de France II: 00001072).

Post‐bath incontinence (bathwater incontinence) can be managed with behavioral therapy

“…Motavasseli et al . reported that vaginal reflux during micturition is an underidentified cause of urinary incontinence in adult women and vaginal finger insertion can be used to manage it as well 3 . In our experience, many women have feelings of resistance toward vaginal finger insertion.…”

“…Motavasseli et al reported that vaginal reflux during micturition is an underidentified cause of urinary incontinence in adult women and vaginal finger insertion can be used to manage it as well. 3 In our experience, many women have feelings of resistance toward vaginal finger insertion. Thus, to evacuate entrapped fluid, it may be a much more acceptable method to put a towel between the legs and apply abdominal pressure or cross the legs after bathing.…”

Transient urocolpos due to vesicovaginal reflux in a 37-year-old woman: a case report

“…Obstructive vaginal lesions and urogenital malformations are frequently associated with this condition. Obstructive lesions appear early in life, but VVR typically occurs in prepubertal girls with a prevalence rate of 12-15% and is anticipated to become nearly absent in middle age, which is rationally described by gradual bladder descent and anatomical modification of the vesicourethral angle [ 3 , 6 , 7 ]. There are few reports of VVR causing urocolpos in adult women, such as Motavasseli et al .…”

“…It is commonly seen in children and is caused by an anatomical abnormality such as the vaginal septum, hypoplastic vagina, or imperforate hymen [ 2 ]. VVR typically occurs in young children and prebuttal females with a prevalence rate of 12-15% and is anticipated to become nearly absent in middle age [ 3 ]. This condition has a variable clinical presentation, including abdominal pain, abdominal distension, urinary incontinence, recurrent urinary tract infections (UTIs), nocturnal enuresis, vaginitis, and vaginal discharge [ 4 ].…”

“…The occurrence of hydrocolpos due to VVR after a Caesarean section in adult females is very rare and may be misdiagnosed as a vesicovaginal fistula [ 3 , 5 ]. VVR is frequently diagnosed by urologists; however, it is less frequently diagnosed by radiologists, resulting in diagnostic challenges [ 2 ].…”