(136) Long-term Durability of Response to Complete Vestibulectomy Surgery for Neuroproliferative Vestibulodynia

Abstract

Abstract Introduction In 2006, Goldstein et al published on the surgical outcomes of the largest-to-date patient series undergoing complete vestibulectomy with vaginal advancement flap reconstruction for neuroproliferative vestibulodynia (NPV). One hundred and thirty-four patients underwent surgery over a 5 year period, and 93% of the 104 patients who agreed to participate were satisfied/very satisfied with their surgical outcome. The mean time to follow up was 26 months, range 12 – 72 months. NPV is hypothesized to be, in part, a result of accumulation of excess mast cells in the epithelial basement membrane and sub-epithelial stroma that may release nerve growth factor promoting sub-epithelial nerve ending proliferation (Figure 1). The excess nerve endings are hypothesized to result in bothersome, persistent, and unrelenting provoked vestibular allodynia and hyperalgesia that are characteristic of NPV. Durability of post-operative outcomes past 72 months has yet to be addressed. It is still unknown if the pathologic findings of excess mast cells and nerve endings ever regenerate in the vestibule and cause recurrent allodynia, hyperalgesia and entrance dyspareunia. Objective We wished to assess, for the first time, the long-term surgical outcome durability data (>5 years) of those NPV patients who claimed successful resolution of their entrance dyspareunia following complete vestibulectomy surgery in the first 5 years post-operatively. 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 those who claimed successful resolution of their entrance dyspareunia following complete vestibulectomy surgery in the first year post-operatively and thereafter for the next 4 years, and asked them if they continued to have resolution of their entrance dyspareunia. Results Fifty-seven patients had complete vestibulectomy with vaginal advancement flap reconstruction between 2007 and 2017 (> 5 years ago). Forty-one patients responded to the routine contact for long term follow-up. Thirty-four patients (78%) had resolution of pain in the first year post-operatively. Upon repeat interview, all 34 (100%) continued to note excellent durability of their surgical result, a mean of 9.3 years after their vestibulectomy (range 5-14 years). Conclusions Based on this small series, it appears that if a patient is a treatment responder following complete vestibulectomy, there is strong durability of the surgical result with no evidence of recurrent allodynia or hypoalgesia. 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 may be an important long-term treatment strategy in many NPV patients. Disclosure No