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]
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| 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.
[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#
