Comparable results achieved with marsupialization vs. Word catheter in Bartholin’s abscess/cyst.

 It is estimated that approximately 2% of women of reproductive age will develop Bartholin cyst/abscess once in their lifetime.[1] Culture results showed causative organisms as E. coli in 43.7% of cases with 37% recurrence in future.[2]

Word Catheter 

A review of literature identified multiple treatments for the condition, but failed to single out any one as the best approach. [3] A recent article by Brazilian researchers published a case series of 31 patients treated with CO2 laser quoted 17% recurrence after the procedure.[4]

The use of Word balloon catheter relieves pain immediately, well accepted and has low recurrence in the future. It is also cost effective in saving precious clinical time, healthcare resources and does not require anesthesia as compared to marsupialization.

Studies comparing the efficacy of both the procedures in terms of recurrence are few and not well designed. A Randomized Control Trial (RCT) by Kroese et al. published in the current issue of BJOG An International Journal Of Obstetrics and Gynecology compares the recurrence rate of both the procedures.

It was a multicentric, open-label, well designed randomized controlled trial conducted at eighteen hospitals in Netherlands and one in England between August 2010 and May 2014.

The study recruited 169 women with Bartholin cyst or abscess and allocated them to either receiving Word catheter (n = 82) or marsupialization (n = 79).

The investigators were primarily interested to study the difference in recurrence rate at the end of year. Other secondary outcomes studied were pain scores, use of analgesics and time to treatment from diagnosis.

Ten women (12%) suffered a recurrence in Word Catheter arm as compared to eight women (10%) in marsupialization arm. (RR) 1.1; P = 0.70. Pain scores were also comparable although patients in Word catheter arm used more analgesic in first 24 hours.

The authors stated “In our opinion, our data therefore favor treatment of a Bartholin cyst or abscess with a Word catheter since this is the fastest procedure, relieving pain sooner after diagnosis, with less cost than when marsupialization is performed.”

The study has several advantages of being generalizable to large population, robust follow-up of 1 year and being adequately powered.

The drawback is diabetes was not included as a confounding factor, which could have affected the recurrence rate in some patients.

  

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[1] Lee MY, Dalpiaz A, Schwamp R, Miao Y, Waltzer W, Khan A. Clinical pathology of Bartholin’s glands: a review of the literature. Curr Urol. 2015;8:22–25. doi: 10.1159/000365683.

[2] Kessous R, Aricha-Tamir B, Sheizaf B, Steiner N, Moran-Gilad J, Weintraub AY. Clinical and microbiological characteristics of Bartholin gland abscesses. Obstet Gynecol. 2013;122:794–799. doi: 10.1097/AOG.0b013e3182a5f0de

[3] https://www.ncbi.nlm.nih.gov/pubmed/19445813

[4] https://www.ncbi.nlm.nih.gov/pubmed/27074230#