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Labial Fusion with Urinary Retention Complicated by Possible Chronic Kidney Disease in a 13-Year-Old Girl

Seen by Dr BN.

Patient Identification

13-year-old female.

History of Presenting Complaint

The patient was brought to the hospital by her mother due to fatigue. Over the past four months, the patient’s mother noticed that she became increasingly tired and unable to carry out her daily chores. The patient also had long-standing abdominal pains associated with abdominal distention.

Past History

  • Since early childhood, the patient has taken longer than every other kid at home to void the bladder. Sometimes, she feels the urge to urinate but is unable to do so.
  • The patient underwent umbilical hernia repair 13 months ago during a mobile health campaign. However, the hernia recurred 3 months ago.
  • Last Menstrual Period: Patient yet to experience menarche.

Physical exam

  • Pale mucosae
  • A tender, round-shaped, smooth, and dull (on percussion) suprapubic mass extending to about 5 cm above the umbilicus
  • A 4 cm umbilical defect
  • Normal breast and pubic hair development for age
  • A fused anterior third of labia majora; urethral meatus not visualized; normal intact hymen.
Attending’s diagrammatic description of findings after inspection of external genitalia.

Further Investigations

  • Abdominal ultrasound: distended bladder with thickened walls, bilateral ureteral and pyelocaliceal dilation. Normal uterus and uterine adnexa.
  • Haemoglobin: 6.3 g/dL
  • Urea/creatinine: 6 mg/dL / 21.1mg/dL (for an eGFR of 2.2 mL/min/1.73m^2)

Final diagnosis

Labial fusion with urinary retention complicated by possible chronic kidney disease.

Management

The patient underwent suprapubic urinary catheter placement, blood transfusion, and was referred to a nephrologist.

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