For labial adhesions, observation alone is reasonable for the asymptomatic child, as they typically resolve once the child reaches puberty and the tissues become estrogenized If the girl is symptomatic, or the parents are concerned, the adhesions can be treated with topical estrogen cream (Premarin 0.1% twice daily for to weeks) followed by petroleum jelly at bedtime to keep the labia from refusing Side effects may include hyperpigmentation and breast tenderness, which resolve after the cream is discontinued Alternatively, after application of a topical anesthetic cream, the adhesions can be bluntly divided with a finger or a probe, and then copious petroleum jelly should be applied up to three times a day (or with every diaper change) for several months However, adhesions can recur RENAL COLIC/NEPHROLITHIASIS CLINICAL PEARLS AND PITFALLS A febrile obstructing stone is a true urologic emergency, and can result in significant morbidity and even mortality, if not appropriately diagnosed in an expeditious manner Goals of Treatment Determining when nephrolithiasis requires emergent treatment versus when supportive care in conjunction with medical expulsion therapy is indicated is of key importance The primary goal in the acute setting is diagnosing obstruction, when it is present, and providing pain control, nausea control, hydration, and education Clinical Recognition A kidney stone becomes a true emergency when it is associated with a fever, or if there is an obstructing stone in a solitary kidney Aside from these two settings, management rests on symptom control and stone expulsion Triage Considerations Fever in the setting of an obstructive stone is a medical and surgical emergency, and without timely treatment, a patient can progress to sepsis, with the potential for rapid decompensation Moreover, obstruction in a solitary kidney can lead to acute renal failure Patients with two functional kidneys who present with pain and/or nausea due to stones and without fever require only symptomatic treatment