Un'incontinenza urinaria che si risolve togliendo un "tappo"... vaginale

We report the case of a healthy 13-year-old girl who presented with sudden-onset total urinary incontinence, both diurnal and nocturnal, occurring in the absence of any voiding urge, with no history of trauma. Initial investigations (abdominal ultrasound, uroflowmetry, nephrological assessment, lumbosacral MRI, and neurological evaluation) were normal, with a regular urinary flow and no post-void residual, initially suggesting a functional or, less likely, a subtle neurological cause. The only abnormal findings were urine cultures positive for recurrent Escherichia coli infections. The turning point came during urodynamic study, which showed continuous leakage of urine from the vagina despite complete bladder emptying, suggesting an abnormal communication between bladder and vagina. Voiding cystourethrography revealed an intravaginal foreign body with a suspected vesicovaginal fistula, confirmed by pelvic ultrasound. Surgery allowed removal of a foreign body (a spray bottle cap) firmly lodged in the vaginal fornix and surrounded by reactive mucosa, which had caused a trigonal vesicovaginal fistula; the fistula was surgically sutured with a favourable outcome. This case highlights the importance of considering rare organic causes, such as fistulae or retained vaginal foreign bodies, in cases of acute and persistent urinary incontinence in childhood, especially with continuous leakage and absence of voiding urge.