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Management Variation in Pediatric Labial Adhesions: A Retrospective Cohort Study
Riley J O'Keefe1, Sarah D Compton1, Melina L Dendrinos1
1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
Insights
Nonsurgical treatment is effective for most labial adhesions (LAs). Management approaches showed minor differences between pediatric and adolescent gynecologists (PAGs) and pediatric urologists (PURs), with no significant variation in surgical intervention rates.
Area of Science:
- Pediatric Gynecology
- Pediatric Urology
- Adolescent Medicine
Background:
- Labial adhesions (LAs) are common in pediatric patients.
- Management strategies can vary among different medical specialists.
Purpose of the Study:
- To compare treatment and outcomes for labial adhesions (LAs) managed by primary care providers (PCPs), pediatric and adolescent gynecologists (PAGs), and pediatric urologists (PURs).
Main Methods:
- Retrospective cohort study of patients aged 0-21 years.
- Analysis of management variations using cross-tabulations and statistical tests.
- Inclusion criteria based on ICD-9/10 codes for LA.
Main Results:
- 159 patients analyzed; 81 managed by PCPs, 78 referred to specialists (41 PUR, 32 PAG).
- Nonsurgical treatment was initial approach for all patients.
- Surgical intervention rates did not differ between PAGs and PURs; PURs performed sharp adhesiolysis more often.
Conclusions:
- Nonsurgical treatment remains effective for the majority of labial adhesion cases.
- Minor variations exist in LA management between PAGs and PURs.
- Further research could explore long-term outcomes across different management pathways.
Objective:
To compare treatment and outcome differences between primary care providers (PCPs), pediatric and adolescent gynecologists (PAGs), and pediatric urologists (PURs) in management of labial adhesions (LAs).
Study Design:
This was a retrospective, cohort study of patients aged 0 through 21 presenting for a clinic visit from July 2022 to July 2023 at a single institution, identified by International Classification of Diseases 9th revision/10th revision codes for LA. Management variation was analyzed via cross-tabs with chi-square, Fisher exact test, and two-sample t-tests.
Results:
The 159 patients meeting inclusion criteria had a median age of 12 months at diagnosis; 81 were managed by a PCP and 78 were referred to a specialist: 41 (52.6%) PUR, 32 (41.0%) PAG, and 5 (6.4%) other specialists. Forty-one patients presented with urinary issues, with no difference in rate of referral to PUR (37.8%), PAG (15.5%), or continued PCP management (46.7%), P = .17. All patients were initially treated nonsurgically. Surgical intervention rates did not differ between PAG and PUR (P = .21). PUR performed sharp adhesiolysis more often than PAG (P = .011), but there was no difference in blunt adhesiolysis rates between PAG and PUR (P = .17). LA recurred postoperatively in 6 (3.8%) patients.
Conclusions:
These results reiterate the efficacy of nonsurgical treatment for most patients with LA and illustrate minor variation in LA management between PAG and PUR.
