Skip to main content

Advertisement

SpringerLink
Log in

Pediatric urethrovaginal reflux: an underestimated cause of urinary incontinence and its successful management

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Urethrovaginal reflux (UVR) secondary to vaginal urine entrapment is an unnoticed cause of daytime urinary leakage in toilet-trained girls. Our aim is to emphasize the diagnosis of UVR as a cause of urinary incontinence, its predisposing factors, early detection, and treatment.

Methods

A total of 25 girls aged between 9 and 14 years presented with mixed daytime urinary incontinence from 2019 to 2021. They were evaluated by detailed history, vaginal examination, focused neurological examination, bladder diaries, urine analysis, uroflowmetry, and residual urine assessment. Micturating cystourethrography was also performed in those girls who did not show improvement with a conservative line of management.

Results

The parents of these girls were educated about the cause of leakage. They were treated with behavioral modifications, urotherapy, correcting toilet postures, and reverse sitting on the commode. Urethrovaginal reflux was found in 6 of the 25 girls (24%). Their ages were 9, 10, 10, 11, 12, and 14 years respectively. Two girls (10 and 14 years old) had a body mass index more than 25. They all had a typical history of a small quantity of urine leakage 5–10 min (post-micturition dribble) after every void. At follow-up after 12 months, all of them were free from urinary incontinence.

Conclusions

Urethrovaginal reflux should be considered in the differential diagnoses of girls with day-time incontinence. The key to diagnosis is an appropriate and detailed history as it is common for parents or girls to ignore symptoms or fail to report them. Proper voiding instructions and behavioral therapy often resolve the problem.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BMI:

Body mass index

CECT KUB:

Contrast-enhanced computed tomography kidney, ureter, and bladder

EUA:

Examination under anesthesia

MCU:

Micturating cystourethrography

UVR:

Urethrovaginal reflux

VUA:

Vulvar urethral angle

VVF:

Vesicovaginal fistula

References

  1. Robson WL, Leung AK. An approach to daytime wetting in children. Adv Pediatr. 2006;53:323.

    Article  PubMed  Google Scholar 

  2. Meadow SR. Day wetting. Pediatr Nephrol. 1990;4:178.

    Article  PubMed  CAS  Google Scholar 

  3. Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006;176:314.

    Article  PubMed  Google Scholar 

  4. Kelalis PP, Burke EC, Stickler GB, Hartman GW. Urinary vaginal reflux in children. Pediatrics. 1973;51:941–3.

    Article  PubMed  CAS  Google Scholar 

  5. Bauer S, Koff SA, Jayanthi VR, editors. Voiding dysfunction in children: neurogenic and non-neurogenic. Philadelphia: Saunders; 2002.

    Google Scholar 

  6. Kilicoglu G, Aslan AR, Oztürk M, et al. Vesicovaginal reflux: recognition and diagnosis using ultrasound. Pediatr Radiol. 2010;40:114–7.

    Article  PubMed  Google Scholar 

  7. Bernasconi M, Borsari A, Garzoni L, Siegenthaler G, Bianchetti MG, Rizz M. Vaginal voiding: a common cause of daytime urinary leakage in girls. J Pediatr Adolesc Gynecol. 2009;22:347–50.

    Article  PubMed  Google Scholar 

  8. Mattsson S, Gladh G. Urethrovaginal reflux–a common cause of daytime incontinence in girls. Pediatrics. 2003;111(1):111–39.

    Article  Google Scholar 

  9. Chiang I, Shei-Dei Yang S, Chang SJ. Pathophysiology of daytime urinary incontinence in children. Pelvic Floor Dysfunct. 2011;5:107–10.

    Google Scholar 

  10. Engel D, Stobbe G, Schöne D. The vaginal influx and its significance in the diagnosis of infections of the urinary tract. Int Urol Nephrol. 1979;11(4):317–23.

    Article  PubMed  CAS  Google Scholar 

  11. Butcher C, Donnai D. Vaginal reflux and enuresis. Br J Radiol. 1972;45(535):501–2. https://doi.org/10.1259/0007-1285-45-535-501.

    Article  PubMed  CAS  Google Scholar 

  12. Stannard M, Lebowitz R. Urography in the child who wets. AJR Am J Roentgenol. 1978;130:959–62.

    Article  PubMed  CAS  Google Scholar 

  13. Hellerstein S, Linebarger JS. Voiding dysfunction in pediatric patients. Clin Pediatr (Phila). 2003;42:43.

    Article  PubMed  Google Scholar 

  14. Motavasseli D, Charlanes A, Chesnel C, et al. Urethro-vaginal reflux during micturition: an underestimated cause of urinary incontinence in adult women. Neurourol Urodyn. 2019;38:1953–7.https://doi.org/10.1002/nau.24098

    Article  PubMed  Google Scholar 

  15. Kato K, Hirabayashi H, Matsuyama A, et al. Post-bath incontinence (bathwater incontinence) can be managed with behavioral therapy. IJU Case Rep. 2022;5(3):203–6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Linshaw MA. Controversies in childhood urinary tract infections. World J Urol. 1999;17:383–95.

    Article  PubMed  CAS  Google Scholar 

  17. Davis LA, Chunley WF. The frequency of vaginal reflux during micturition—its possible importance to the interpretation of urine cultures. Pediatrics. 1966;38:293–4.

    Article  PubMed  CAS  Google Scholar 

  18. Sakakibara R, Tsunoyama K, Hosoi H, et al. Influence of body position on defecation in humans. Low Urin Tract Symptoms. 2010;2(1):16–21.

    Article  PubMed  Google Scholar 

  19. Bhattacharya S, Chattu VK, Singh A. Health promotion and prevention of bowel disorders through toilet designs: A myth or reality? J Educ Health Promot. 2019;8:40

  20. Ollendick TH, King NJ, Frary RB. Fears in children and adolescents: reliability and generalizability across gender, age and nationality. Behav Res Ther. 1989;27:19.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. NU Hospitals (South), 6, 15th main, 11th cross, Padmanabhanagar, Bangalore, 560070, Karnataka, India

    Vinod Kumar Prabhuswamy, Venkatesh Krishnamoorthy & Prasanna Matippa

Authors
  1. Vinod Kumar Prabhuswamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Venkatesh Krishnamoorthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prasanna Matippa
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors have approved the submitted version (and any substantially modified version that  involves the author's contribution to the study) and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally  involved, are appropriately investigated, resolved, and the resolution documented in the literature. Dr Vinod Kumar and Dr Venkatesh Krishnamoorthy contributed by preparing the concepts and designing the paper. They did literature search, went through clinical studies, acquired and analyzed the data. Dr Vinod Kumar and Dr Prasanna Matippa together did the statistical analysis, prepared the Manuscript, edited and reviewed at the end. Dr Venkatesh Krishnamoorthy also edited the final copy of Manuscript. Dr Prasanna Matippa defined the intellectual content and helped in preparing concepts.

Corresponding author

Correspondence to Vinod Kumar Prabhuswamy.

Ethics declarations

Ethical approval and consent to participate

The protocol for this research project has been approved by the Ethics Committee of the institution, NU Hospitals—Ref No. NUH/IEC/2022/09/07. All subjects have given appropriate consent to participate.

Consent for publication

Written informed consent to publication was obtained.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Prabhuswamy, V.K., Krishnamoorthy, V. & Matippa, P. Pediatric urethrovaginal reflux: an underestimated cause of urinary incontinence and its successful management. Int Urogynecol J 34, 3013–3021 (2023). https://doi.org/10.1007/s00192-023-05650-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-023-05650-x

Keywords

Search

Navigation