(089) Regional Vestibulectomy and Buccal Mucosal Graft Reconstruction for Refractory Neuroproliferative Vestibulodynia

Abstract Introduction Buccal mucosal grafts (BGM) are widely used in male urethral reconstruction and have more recently been reported for female reconstruction. We report the first case of using a buccal mucosa graft (BMG) to cover excised 12:00 vestibule 19 year old woman with lifelong persistent genital arousal disorder (PGAD) presumed secondary congenital neuro-proliferative vestibulodynia. She presented our clinic at 17 underwent lysis clitoral adhesions, excision core region primary closure, complete vestibulectomy vaginal advancement flap. Her vestibular specimen positively stained CD117 PGP9.5 consistent excess mast cells nerves, respectively. Post-operatively, there was marked reduction pain 1:00 11:00 posteriorly, however she had PGAD significant residual tenderness cotton-tipped swab testing region. medically managed successfully tramadol, clonazepam low dose zolpidem. Desiring eliminate need systemic medications, patient returned age 19. Again, local anesthesia applied clitoris resulted clinically symptom discussed repeat re-excision BMG Objective To on novel technique one distressing vestibulodynia PGAD. Methods Pre-operative counseling included discussion routine surgical risks, benefits, alternatives, additional possible complications including failure procedure relieve or vestibulodynia, contracture, harvest site sexual dysfunction, disfigurement. The gave consent adhesions regional subepithelial vestibulectomy. defect measured 2.5 cm x cm. A non-tubularized onlay patch harvested procedures were performed by single surgeon. discharged same day. Results patient’s post-operative course notable acute urinary retention recovery room. foley catheter passed voiding trial post-op day 1. well-controlled non-opioid medications able resume soft food diet immediately after surgery. At week 5, area, site, healed without complication. reports that her touch has resolved. decreased slightly, although not yet attempted discontinue oral medications. Conclusions For this patient, appears safe feasible refractory neuroproliferative Given is endodermal origin derived from urogenital sinus, neuroproliferation may represent anomaly, rationale replace sinus endoderm non-urogenital such as mucosa. should include surgery specific adverse events like mouth opening restriction Longer follow up larger studies needed. Disclosure No