(022) Durability of Vestibulectomy Surgery for Neuroproliferative Vestibulodynia

Abstract

Abstract Introduction In 2006, Goldstein et al reported on 134 patients who underwent complete vestibulectomy surgery with vaginal advancement flap reconstruction for neuroproliferative vestibulodynia (NPV). Ninety-seven of 104 participants (93%) noted being satisfied/very satisfied with surgical outcome. The mean duration of follow up was 26 months (12 – 72 months). NPV is a genital pain condition hypothesized to be caused by an accumulation of excess mast cells in the vestibular epithelium and sub-epithelial stroma that release nerve growth factor. This promotes sub-epithelial stromal nerve ending proliferation (Figure 1). The excess nerve endings result in bothersome, persistent provoked vestibular allodynia and hyperalgesia. Durability of post-operative outcomes past 72 months has not been previously characterized. It is yet unknown if the immunohistochemical pathologic findings of excess mast cells and nerve endings ever reaccumulate in the vestibule, causing recurrent allodynia, hyperalgesia and entrance dyspareunia. Objective We assessed the long-term surgical outcome durability (>6 years) of resolution of pain from total vestibulectomy with vaginal advancement flap reconstruction. Methods We routinely perform post-operative follow-up of surgical patients who undergo complete vestibulectomy surgery with vaginal advancement flap reconstruction for NPV. We identified patients who claimed successful resolution of their entrance dyspareunia at least 72 months after complete vestibulectomy surgery. We contacted them to determine whether or not they continued to have resolution of their entrance dyspareunia. Results 57 patients have had complete vestibulectomy surgery with vaginal advancement flap reconstruction from 2007 – 2016 (> 6 years ago). 41 patients responded to long term follow-up contact. 34 patients (78%) were satisfied/very satisfied with surgical outcome in the first 72 months post-operatively. All 34 (100%) continued to note excellent durability of their surgical result, still claiming being satisfied/very satisfied with surgical outcome, a mean of 9.3 years post-op (range 5-14 years). Conclusions Based on this small series, it appears that if a patient is a treatment responder to complete vestibulectomy surgery, there is strong durability of the surgical result. These data suggest that in treatment responders, there is no evidence of re-accumulation of excess mast cells and nerve endings in the introitus. These data support that the pathology of NPV lies in the endodermal vestibule and that complete excision is an important long term treatment strategy in many NPV patients. Disclosure No