What is your diagnosis? Labial adhesions – Classification and treatment

Abstract

An 8-month-old Caucasian female infant with a history of two urinary tract infections presented with fever, poor oral intake, and increased irritability for 3 days prior to presentation. The mother reported a fever T max 103F and a strong odor of urine. Mother denied any cold, cough, diarrhea, vomiting, rash, and sick contacts at home. Her initial vitals were normal other than a temperature of 101F. The infant was alert, active and comfortable in her mother’s lap. On examination of her external genitalia, there was fused labia minora at the midline forming a midline raphe, and pinhole urethral opening was also noted (Figure 1). Due to close approximation of labia minora and tiny urethral opening, we were unbale to catheterize the bladder. According to the mother, previous attempts to catheterize the bladder for urinary samples were never successful as well. We confirmed the labial adhesions as shown in (Figure 1) based on our clinical examination and a presumptive diagnosis of UTI was made based on a positive bag urine sample and her symptoms.