title: Labial adhesion and urinary tract problems: The importance of genital examination.
abstract: BACKGROUND
  Urinary tract infection (UTI) is a common bacterial illness in children. Delay in the treatment of UTI may lead to acute renal parenchymal damage and subsequent renal scarring. It is well established that several risk factors increase the tendency for UTI - one being labial adhesion (LA).
  
  
  OBJECTIVE
  The purpose of this study was to emphasize the importance of genital examination in girls with nephrourologic symptoms, particularly UTIs, in order to detect LA.
  
  
  METHODS
  Data were collected from the files of 46 girls with LA, including: the girl's age, thickness of LA, any recurrence and treatment options of LA, and the reason for admission to hospital. The LAs were grouped in terms of thickness as thin, moderate and dense, and also partial or complete.
  
  
  RESULTS
  The average age of the girls at the first visit was 51.9 ± 37.57 months (min-max: 3.5-157 months). Twenty-seven (58.7%) of the girls had history of recurrent UTI. There was a marked association between the presence of UTI and the type of adhesions. The percentages of UTIs in girls with complete and partial LA were 84.0% and 28.6%, respectively (P < 0.05). The percentages of UTIs in girls with thick and thin LA were 100% and 44.1%, respectively (P < 0.05). None of the girls' primary care physicians or pediatricians recognized LA at the time of a periodic health examination.
  
  
  CONCLUSIONS
  In the present study, girls with complete and thick LA had a greater tendency towards having UTIs than those with partial and thin LA, respectively. After treatment of LA, the UTIs did not recur in any girls. None of the girls in this study had undergone a previous genital examination. Therefore, this study suggests that physicians do not often perform genital examinations. Limitations of this study were the small sample size and the short follow-up period. In addition, although all of the girls were examined by the same physician, the thickness of the membrane is subjective and solely depends on the physician's experience.
  
  
  CONCLUSIONS
  This study showed that although genital examination is a routine part of a physical examination, it is not always performed. Therefore, it is recommend that genital examination should be performed in girls with nephrourologic complaints, particularly for UTI. By timeously determining the presence of LA, many unnecessary and invasive investigations could be avoided in these children.
authors.affiliation: Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey; Department of Pediatrics, Kocaeli Derince Teaching and Research Hospital, Kocaeli, Turkey. Electronic address: enginmelek@hotmail.com.
authors.forename: Engin
authors.initials: E
authors.lastname: Melek
authors.affiliation: Department of Pediatrics, Kocaeli Derince Teaching and Research Hospital, Kocaeli, Turkey. Electronic address: fatihkilicbay@mynet.com.
authors.forename: Fatih
authors.initials: F
authors.lastname: Kılıçbay
authors.affiliation: Department of Pediatric Surgery, Kocaeli Derince Teaching and Research Hospital, Kocaeli, Turkey. Electronic address: neclagurbuz@yahoo.com.
authors.forename: N G
authors.initials: NG
authors.lastname: Sarıkaş
authors.affiliation: Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: akbayazit@gmail.com.
authors.forename: A K
authors.initials: AK
authors.lastname: Bayazıt
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000150:complications* / Q000175:diagnosis; D005836:Genitalia, Female / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D010808:Physical Examination; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000150:complications* / Q000175:diagnosis; D014567:Urography
keywords: Children; Genital examination; Labial adhesion; Urinary tract infection