Word catheter or marsupialization for a Bartholin gland cyst or abscess?  

FINDINGS:

In a well-designed randomized control trial (RCT), investigators sought to determine as a primary outcome whether a Word catheter or marsupialization worked better at preventing a recurrence of a Bartholin gland cyst or abscess, sufficiently symptomatic to require treatment, within 1 year of treatment. Upon comparing women randomized to Word catheter (n = 82) or to marsupialization (n = 79), the researchers found:

There were no differences in

• Recurrence of cyst or abscess requiring treatment within a year (Word 12.2% vs. marsupialization 10.3%)
• Pain scores 24 hours and beyond after treatment

There were significant differences in

• Maximal and average pain experienced during treatment were higher in the Word catheter group compared to the marsupialization group
• Analgesic use, where 34% of women required analgesics in the Word group compared to 74% in the marsupialization group (P < 0.001) in the first 24 hours after treatment
• Time from diagnosis to treatment was 1 hour for the Word group compared to 4 hours for the marsupialization group (P < 0.001)

SYNOPSIS:

Women have a lifetime risk of 2% for Bartholin cysts and abscesses. Surgical excision of the gland has been replaced by marsupialization where the abscess is drained and the edges of the incision are sutured such that skin to interior is a continuous surface and an outflow tract can be maintained. In 1963, Dr.Buford Word developed a catheter that could be placed in the abscess cavity and left in situ to serve as a drain. The authors sought to compare Word catheter placement and marsupialization directly. The multi-centered study, called the WoMan trial (Word versus marsupialisation) involved 18 hospitals in the Netherlands and one hospital in England.

KEY POINTS:

• Word catheter placement was performed without anesthesia or using local anesthesia, while marsupialization was performed primarily under spinal or general anesthesia
• Strengths of this study include close to 100% follow up at 1 year
• Multiple providers were involved and pain questionnaire responses were limited to 66%
• Data from this study favors the use of outpatient Word catheter placement which was well tolerated by patients, required less analgesia following the procedure and would result in cost savings

Learn More – Primary Sources:

BJOG: Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial

Related ObG Topics:

Levels of Evidence – How to Rate the Quality of a Study