[Vaginal reflux: A forgotten cause of diurnal incontinence in prepubertal girls].

Most cases of daytime incontinence in prepubertal girls have a functional aetiology, although a neurogenic dysfunction must always be ruled out. Vaginal reflux (VR) or intravaginal urination has been recognised as a cause of urinary incontinence with post void dribbling in prepubertal girls. The reverse flow of urine into the vagina can sometimes be perceived in a retrograde voiding cystourethrogram (VCUG), even in a standing position. This finding, which is frequent in prepubertal girls, may be asymptomatic or accompanied by symptoms such as diurnal incontinence and recurrent vulvovaginitis. Incontinence is characterised by loss of urine in the daytime (accompanied by enuresis in some cases) usually soon after urinating (post void dribbling) due to the progressive emptying of the vagina. We present 3 cases of VR that showed the usual clinical features of exclusively diurnal incontinence. Case 1. Girl, 7 years of age, with overweight and symptoms of diurnal incontinence consisting of post void dribbling without enuresis. She reported occasional urgency and 3--4 episodes a year of afebrile urinary tract infection (UTI). We performed an ultrasound and a VCUG, with normal results. A uroflowmetry and urodynamic assessment were performed and showed no signs of pathology (coordinated urination without residual urine, no overactivity, correct voiding). Two filling cystometries were performed, the second of which (with the patient in a seated position) revealed a leakage that had not been detected in the first one. At first we considered the possibility of sphincter deficiency and we performed a magnetic resonance imaging study of the lumbosacral spine that showed no abnormalities. We