(82) Management Variation in Pediatric Labial Adhesions

Background: There is a paucity of data on management and outcomes in pediatric patients with labial adhesions (LA). This study explores management differences between pediatricians, pediatric gynecologists (PAG) and pediatric urologists (PUR) with respect to surgical and non-surgical approaches to treatment of LA.

Methods: This was a retrospective chart review of patients 0-21 years old who presented for a clinic visit from July 2022 to July 2023 at a single institution. Patients were identified by ICD 9 and ICD 10 codes for LA. Patients were excluded if records were incomplete or if LA was secondary to another condition. Data collected included patient demographics, body mass index at time of diagnosis, history of urinary tract infection (UTI) and/or urinary retention, specialties of providers, treatments employed, time from diagnosis to surgery, and recurrence rate. Variation in management of LA was analyzed via cross-tab, two-sample t test, Pearson Χ2, and Fisher’s exact tests. This study was approved by the IRB.

Results: 160 patients met inclusion criteria. Ages ranged from 0 months to 8 years at the time of diagnosis (median 12 months). Seventy (43.8%) patients were referred to a specialist, and 90 (56.2%) were managed by the initial diagnosing provider. Of the 70 referrals, 27 (38.6%) were placed to PAG, 28 (40%) were placed to PUR, and 15 (21.4%) were placed to other specialists. Twenty-eight (17.5%) patients presented with history of a UTI, and 17 (10.6%) had urinary retention at the time of diagnosis. Of the 45 patients presenting with a history of UTI or urinary retention, there was no difference in rate of referral to PUR, PAG, or pediatricians (37.8% vs. 15.5% vs. 46.7%, p < 0.17). Initial management of LA was nonsurgical across all specialties: 96 (60%) patients were treated with topical estrogen, 33 (20.6%) with a topical emollient, 25 (15.6%) with observation, 4 (2.5%) with betamethasone, and 2 (1.3%) with manual traction. Surgical versus nonsurgical intervention did not differ between PAG and PUR (p < 0.21). There was no difference in time from diagnosis to surgery between PAG and PUR (p < 0.38) with average time to surgery of 22 months. PUR performed sharp lysis of adhesions at higher rates than PAG (p < 0.01), but there was no significant difference in rates of blunt adhesiolysis using a coated q-tip between PAG and PUR (p < 0.17). LA recurred in 6 (3.8%) patients following surgical lysis.

Conclusions: Among patients being treated for LA, referral to PUR versus PAG did not significantly alter the course of treatment or likelihood of surgical intervention. When taken to the OR, PUR were more likely to perform sharp lysis of adhesions.