Gross nonobstructive urocolpos secondary to vesicovaginal reflux – a case report

Posted By Amin Hoseinzadeh
Gross nonobstructive urocolpos secondary to vesicovaginal reflux – a case report

Vesicovaginal reflux (VVR) which is retrograde flow of urine into the vaginal vault during voiding is the commonest cause of urocolpos in the absence of vaginal obstruction. Diagnosis of this condition is usually clinically by urologists and gynecologists and it is therefore rarely encountered by radiologists and so is rarely reported in the radiological literature. We report a case of VVR with describing clinical and radiological manifestations. A 15 year-old adolescent, weighing 54 kg and 1.36 m height (body mass index = 29.2 kg/m2), with a normal menstrual history presented with urinary incontinence since childhood. Clinical examination of the external genitalia was unremarkable. There was continuous dribbling of urine from the vagina. Renal function tests and complete blood counts were within normal limits. Urine examination revealed pyuria with gram negative bacteria. Urine culture reported E. coli. Pelvic ultrasonography demonstrated an anechoic cystic structure posterior to urinary bladder outlined by cervix (Figure 1.). A sonographic diagnosis of hydrocolpos was made with rest of the study being normal. The uterus, ovaries and the urinary bladder were normal. Post micturition sonography showed complete emptying of the vaginal fluid and post void residual urine of 45 ml in the urinary bladder. The ureteric jets on both ureterovesical junctions were normally seen within the bladder. The patient was subsequently referred for vaginoscopy under general anesthesia that revealed no features suggestive of vaginal obstruction. The findings were confirmed on voiding cystourethrogram (VCUG) which represents dynamic reflux of contrast into vagina during early phase of voiding (Figure 2-A and 2-B) with complete evacuation of hydrocolpos by the end of voiding. No vesicoureteral reflux (VUR) was seen bilaterally. The possibility of duplication or ureteral ectopia was also ruled out on intravenous pyelogram (IVP). Gross urocolpos is most often secondary to obstructive causes like imperforate hymen, vaginal septum and vaginal atresia. VVR represents an uncommon cause of urocolpos. The vaginal distention in VVR related urocolpos may be complete, partial or minimal; gross distention has been rarely described especially in pediatric population which makes the present case unusual. VVR is a common functional disturbance which is not related to anatomic or obstructive pathology and is secondary to behavioral factors that prevent the maturation of normal voiding control. Upon voiding, urine passes into the vaginal vault through the introitus. During standing, urine which was pooled in the vagina dribbles out making underclothes wet. Patients are usually prepubertal obese girls whose large labia prevent the passage of urine and who do not put their legs wide enough apart during micturition. The condition has also been reported in thin girls, in cases of hypospadias, labia minora adhesions, ectopic ureter, ureteral duplication and spastic pelvic floor m

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  • Amin Hoseinzadeh 2017-09-19 13:08:24

    Discuss my case please!