it is characterized by a quick loss of renal function , which develops over hours to days .
problems causing obstruction in the urinary system are considered under the topic of post - renal failure .
different precipitating factors that cause obstruction throughout the ureteral trace , urine bladder tumors , and urethral obstructions consequently leads to post - renal failure .
there are multiple well - known etiologies for acute renal failure , but labial fusion in postmenopausal female is a quite rarely encountered pathology among obstructive uropathies and only a few cases have been reported on the association of arf and labial fusion in the postmenopausal female .
it is most commonly seen in prepubertal girls ( especially in the first 2 years of life ) and rarely older women , .
the etiological factor is an association with low estrogen levels , chronic inflammation / irritation of the vulval skin , lichen sclerosus and absence of sexual activity .
most of the time , clinical presentation of labial fusion is urinary complaints as urinary incontinence , urinary frequency , voiding dysfunction and recurrent urinary tract infections , .
we presented a rare case with acute renal failure due to total labial fusion and successful surgical management of a postmenopausal woman with total labial adhesions .
a 92-year - old woman was referred to urogynecologic evaluation for urinary retention for the last 3  days .
she described difficulty voiding , urgency , urinary incontinence , urinary tract infection , vaginal pressure , vulvar itching or irritation for the last 4 years .
she had been evaluated by gynecology and obstetrics department and treated with topical estrogens therapy for 4 weeks without any improvement or side effects .
on urogynecological examination , the external genitalia revealed an atrophic vulva and fused labia minora at the midline .
the fused labia completely covered the vaginal introitus , clitoris , and the external urethral meatus ( fig .
laboratory results were as follows : bun:68  mg / dl , cr:5,6  mg / dl , na:139 meq / l , k:5.1 meq / l , crp:10.7  mg / dl .
the patient was hospitalized for further analysis and treatment . on her ultrasonographic examination ; localization , parenchyma echogenicity were normal ; there was not solid or cystic lesion but moderate pelvocaliectasis in both kidneys .
abdominal and pelvic tomography showed normal gynecologic anatomy and there was no extrarenal pathology . with the suspicion of urethral obstruction and post - renal acute renal failure development due to labial fusion ,
16 gauge catheter was inserted percutaneously into the bladder under ultrasonography guidance to achieve a suprapubic urine diversion .
renal functions returned to normal levels ( bun was decreased to 21  mg / dl from 68  mg / dl , serum cr was decreased to 0,9  mg / dl from 5.6  mg / dl ) within 4  days . according to result of urine culture antibiotherapy
2 ) . there were no anatomical abnormalities in the vaginal canal , cervix and urethral meatus .
3 - 0 vicryl rapide stitches were continuously applied to the edges of skin and vaginal mucosa to form contact with each other ( fig .
3 ) . punch biopsie of the vulvar adhesions was acquired at the time of surgery .
patient was discharged with instructions to perform twice daily topical estrogen and steroids ( clobetasol 0.05% ) to the vaginal introitus for 4 weeks .
the patient was seen for postoperative evaluation at 3 months follow - up after surgery .
she reported complete resolution of all urinary symptoms and no recurrence of labial fusion was noted ( fig .
urologic pathologies causing acute postrenal failure typically result from obstruction of urinary flow and the frequency varies among age groups .
prostatic hypertrophy and malignancies are the most common cause of obstruction in the advanced age groups and vesicoureteral reflux , bladder dysfunction ( including neurogenic bladder ) , and ureteropelvic junction obstructions in the childhood lead to renal disease .
although they are rare , urinary prolapses   and labial fusions ,   are usually encountered in older women .
most of the published data of labial fusion in the postmenopausal female population are case reports , at the same time symptoms in this literature are with related urinary complaints .
agglutination initially occurs only in the posterior aspect of the labia and urethra is  partially  obstructed . in most advanced cases
the urethral and vaginal orifices are  completely  covered by fusion . when the urine can not freely exit the vagina , it can lead to urinary retention and recurrent urinary tract infections . in addition ,
, postmenopausal females with symptomatic labial fusion present with vulvar pruritis , dyspareunia , urinary incontinence , urinary retention , difficulty in voiding , frequency and dysuria .
it has been associated with recurrent trauma , vulvovaginitis and inflammation caused by an infection , mechanical irritation , low endogenous estrogen , atopic eczema or lack of intercourse as causative factors , .
an alternative etiology for these adhesions may include vulvar dystrophies such as lichen sclerosis . in this case ,
biopsy findings showed lichen sclerosus and it seems that the hypoestrogenic state , lichen sclerosus and lack of intercourse were the main participant for the labial fusion .
the first - line management of labial adhesions in the postmenopausal patient is topical estrogen or steroids replacement therapy , although it has not high success rate .
when the topical oestrogens therapy failed , labial separation by means of blunt / sharp dissection is required . in our case , local estrogen treatment was not effective and we performed labial separation by blunt dissection .
postoperative topical steroids and estrogen therapy and daily manual separation of the labia can be used to prevent recurrence of the adhesions . in summary
, we report a case of postmenopausal woman who presented with labial fusion - related urinary retantion and acute renal failure and these adhesions was treated with a combination of surgery and topical steroids and estrogen therapy with complete resolution of the urinary symptoms .
faruk doan and serdar baaranolu ( 1)(3 ) ( 1 ) the conception and design of the study , or acquisition of data , or analysis and interpretation of data .
( 2 ) drafting the article or revising it critically for important intellectual content . ( 3 ) final approval of the version to be submitted .
 acute renal failure is characterized by rapidly disruption in kidney function and postrenal causes typically result from obstruction of urinary flow . 
 multiple etiologies were described for acute renal failure , but labial fusion in postmenopausal female is a quite rarely encountered pathology among postrenal causes . 
 only a few cases have been presented in postmenopausal women presenting with urinary retention . 
 we present a case with acute renal failure due to complete labial fusion in a postmenopausal woman and its treatment . 
Introduction
Case report
Discussion
Authors contribution
Conflict of interest