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

Objective: To compare treatment and outcome differences between primary care providers (PCP), pediatric and adolescent gynecologists (PAG), and pediatric urologists (PUR) in management of labial adhesions (LA).

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 ICD-9/ICD-10 codes for LA. Management variation was analyzed via cross-tabs with chi-square, Fisher's exact, 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.