Urinary incontinence secondary to severe labial agglutination

Abstract

The purpose of the study was to describe the presentation and management of urinary incontinence because of severe labial adhesions. Records of all patients diagnosed with labial agglutination and urinary incontinence at the Division of Gynecologic Specialties between January 1999 and February 2006 were reviewed. Clinical presentation, management, and treatment outcome were extracted from the records. Five subjects were identified. Mean age was 78 (range 59-87) years. Four subjects presented with mixed and one with urge urinary incontinence. Four reported change in flow of stream with voiding. Physical examination showed near-total occlusion of the introitus and urethral meatus in four subjects and partial occlusion in one subject. All were treated topically with estrogen and/or steroids. None of the subjects improved with conservative management, and all required lysis of the labial adhesions. Postoperatively, all were treated with daily topical estrogen and three with concurrent topical steroids. All subjects reported resolution of voiding dysfunction; three had complete resolution of their incontinence. Lysis of labial adhesions combined with postoperative topical estrogen and steroids appears to be an effective treatment in women with this condition.

Severe Labial Agglutination Release in a Postmenopausal Woman

“…In symptomatic postmenopausal women there are typically four methods for treatment including: 1) blunt or sharp separation with local, regional or general anesthesia, 2) manual separation without anesthesia, 3) topical estrogen or steroids, and 4) oral estrogen [1] [5]. Brisk manual separation without anesthesia, however, is not recommended as this can be very uncomfortable for the patient.…”

“…If manual separation is required, topical estrogen and/or steroids are then used to ensure separate healing of the labia [5].…”

“…In post-menarchal females fusion develops secondarily, rather than due to congenital malformation, the possible etiology of this may be a hypoestrogenic state, in conjunction with local irritation and inflammation [1]. Other postulated causes of agglutination include thinning of the vulvar mucosa, poor hygiene, lichen sclerosis, contact with urine, local infection, and mechanical irritants [5]. One study showed that biopsy of the labia of two patients reported chronic and acute inflammatory changes, indicating that inflammation may play a key role in the presence of a hypoestrogenic state to cause agglutination [5].…”

Voiding dysfunction due to long-standing labial fusion in an elderly woman: a case report

“…Symptomatic labial fusion often presents with vulval pruritus and soreness and rarely with urinary incontinence [1,2], voiding difficulties, urinary retention [3] and dysuria.…”

“…It is standard practice to prescribe pre-and postoperative topical estrogens to these patients to alleviate atrophic changes in the epithelium and improve healing. Post-operative topical antibiotics in combination with estrogens have been used to minimize risk of infection, improve healing process and prevent recurrence of fusion [1][2][3].…”