Vesicovaginal reflux: a case report and literature overview

Vesicovaginal reflux (VVR) is a functional voiding disorder characterized by the retrograde flow of urine into the vagina during micturition, often presenting with daytime incontinence or postvoid dribbling. It is commonly underrecognized and may be mistaken for anatomical abnormalities such as vesicovaginal fistula or obstructive hydrocolpos, which require surgical intervention. We report a case of an 8-year-old girl who presented with dysuria, urinary urgency, and fever. Transabdominal and transrectal ultrasounds revealed an anechoic area measuring 7.3 × 3.3 × 4.0 cm in the vagina while urinary bladder was filled, which disappeared after voiding. Pelvic magnetic resonance imaging showed a cystic fluid signal between the bladder and rectum that resolved following urination. Voiding cystourethrography ruled out filling defect, which suggested bladder-vaginal reflux. A literature search of PubMed and Google Scholar from 1972 to the present using the terms "urinary incontinence," "hydrocolpos," and "vesicovaginal reflux" identified 13 relevant articles. Including the present case, a total of 58 cases of VVR were reviewed, ranging from children to middle-aged adults. The diagnosis of VVR should be considered when transient fluid collection is observed in the vagina on ultrasound and disappears after complete voiding. Treatment focuses on behavioral therapy, including proper voiding posture and toileting habits, along with weight control when indicated.