Two Deceptive Genitourinary System Disorders with Similar Symptoms but Different Treatments: Urethrovaginal Reflux and Vesicovaginal Fistula

Abstract

Background: Urethrovaginal reflux is an uncommon cause of voiding difficulties in girls, characterized by the backward filling of the vagina during urination. Symptoms may include vulvovaginitis, vaginal discharge, and an unpleasant odor, which can arise from both pathological and physiological factors contributing to urinary incontinence in young girls. Methods: In one case, a 12-year-old girl with a history of neurogenic bladder due to seizures presented with post-void dribbling and unaware urinary incontinence, enuresis, and recurrent symptomatic urinary tract infections (UTIs). Initially, the possibility of a vesicovaginal fistula was considered. However, both cystoscopy and a dye test returned normal results. The patient was then referred to our center for further evaluation. Findings: A thorough physical examination revealed normal findings. However, urinary leakage from the vagina was observed when the patient was standing or walking. Abdominal and pelvic sonography indicated that the size and cortical thickness of the kidneys were normal, though the bladder wall thickness was increased. Following VCUG and urodynamic tests, urethrovaginal reflux was diagnosed, and the patient received appropriate treatment. Conclusion: Dysfunctional voiding is the most prevalent cause of urinary incontinence in children, with urethrovaginal reflux being a common factor in prepubertal girls. This type of reflux can be seen across anatomical anomalies such as paraaginal web and/or labial adhesions. In most patients, the diagnosis of urethrovaginal reflux is determined through medical history, physical examination, and a bladder diary. However, if accompanied by an overactive bladder or neurogenic bladder, the pattern and severity of urinary incontinence may vary, necessitating further evaluation for accurate diagnosis. © 2025, Isfahan University of Medical Sciences(IUMS). All rights reserved.