Management Variation in Pediatric Labial Adhesions: A Retrospective Cohort Study.

Abstract

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). 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. 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. These results reiterate the efficacy of nonsurgical treatment for most patients with LA and illustrate minor variation in LA management between PAG and PUR.