Management of Bartholin's cyst and abscess using the Word catheter: implementation, recurrence rates and costs

Comparison of Word Catheter and Marsupialization in the Management of Bartholin's Glands: A Systematic Review and Meta-Analysis

OBJECTIVE

There is no consensus on the best option for the management of Bartholin's gland abscesses. This systematic review and meta-analysis aimed to compare the Word catheter placement and marsupialization methods in the management of women with a cyst or abscess of the Bartholin's glands.

DATA SOURCES

The PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases, as well as Google Scholar, were searched to retrieve articles published between January 1990 and July 2023, comparing the Word catheter treatment with marsupialization for women with a cyst or abscess of the Bartholin's glands.

STUDY SELECTION

Both observational studies and randomized controlled trials (RCTs) were included in this meta-analysis.

DATA EXTRACTION AND SYNTHESIS

After the review, out of 9 relevant articles, only 4 (2 observational studies and 2 RCTs) were included in this meta-analysis, providing the data of 735 patients (396 in the Word catheter group vs. 339 in the marsupialization group). The data was extracted from the selected articles, using a data extraction form. Comparison of the Word catheter and marsupialization methods suggested that the risk of recurrence was approximately 7.6% in the Word catheter group and 9.4% in the marsupialization group. The findings indicated no significant difference in the recurrence of cysts or abscesses when comparing the Word catheter treatment with marsupialization (odds ratio = 0.99, 95% confidence interval: 0.29-3.43, P = 0.990, I2 = 77%).

CONCLUSION

This meta-analysis found no significant difference in the rate of recurrence between the Word catheter and marsupialization methods. In general, marsupialization and Word catheter placement in the treatment of Bartholinitis seem to be equally effective.

Encapsulated Hematoma of the Bartholin's Glandule

Bartholin's glands are important organs of the female reproductive system. These glands have the function of producing an alkaline mucoid secretion, which helps in vaginal and vulvar lubrication. There are several types of lesions that can be identified in these anatomical structures, where in most cases presented for medical examination, cysts and abscesses predominate. This is the presentation of a clinical case of a 55-year-old patient, who is presented to the surgeon for her complaints. Once the woman is examined, diagnosed, and treated adequately, she is taken into consideration for presenting her case in this study, while maintaining confidentiality. The presented clinical case provides a clinical framework not easy to establish an accurate diagnosis of a Bartholin gland cyst. Careful physical examination by the surgeon and careful preparation with electrosurgery verified the cyst-hematoma left and just above the posterior fornix, where some material was taken from the cyst capsule and hematoma and sent for histological examination. The histological response concluded with cystic hematoma of the Bartholin gland. Cystic lesions of the vagina are relatively common and usually represent a benign condition. Ways of managing Bartholin gland cysts vary depending on the discomfort they bring to the patient as well as the size or even the anatomical extent of the cystic lesion. However, the physical examination, with a careful inspection by the surgeon, combined with the imaging examinations, requires a biopsy examination, which is the confirmation of the diagnosis.

Acute Bartholin's gland abscess treatment by simple needle aspiration: A prospective study

OBJECTIVE

This study aim was to examine the success rate of simple needle aspiration for acute Bartholin's gland abscess and compare it to incision and drainage treatment.

STUDY DESIGN

This was a non-randomised prospective study conducted at the academic Hospital of La Conception, Marseille, France. We included 202 women who presented with acute Bartholin's gland abscess between June 2013 and October 2017. The study cohort was subdivided into two treatment groups, simple needle aspiration (134 women) or incision and drainage (42 women), according to the women's preference. Success was considered as the absence of surgical treatment within one year of the initial treatment.

RESULTS

The success rate was 68/134 (51% (95% CI: 42-59%)) in the simple needle aspiration group and 25/42 (60%) in the incision drainage group (RR: 0.85, 95% CI: 0.63-1.15, P = 0.3). Among 122/134 (91%) women who completed the satisfaction survey, 99/122 (81%) were satisfied with the simple needle aspiration.

CONCLUSIONS

Simple needle aspiration can be offered as first-line treatment for acute Bartholin's gland abscess. Simple needle aspiration can be performed as an outpatient procedure without general anesthesia avoiding surgical treatment in half of the cases one-year post- simple needle aspiration.

Marsupialization vs word catheter in the treatment of Bartolin cyst or abscess: retrospective cohort study

Objective:

Bartholin cysts or abscesses are observed in approximately 2% of women, usually in their reproductive years. Although none of the treatments appear to be superior, there are several options including drainage with basic incision, Word catheter application, marsupialization, silver nitrate application, and excision. The primary outcome in this study was to evaluate the recurrence rates in patients who underwent marsupialization or Word catheter for the treatment of Bartholin cyst or abscesses, and the secondary outcome was to evaluate the rates of patient satisfaction.

Material and Methods:

A total of 196 patients who underwent either Word catheterization or marsupialization for the treatment of Bartholin cyst or abscesses between 2014 and 2017 were included in this retrospective cohort study. The size and location of the cyst/abscess, the operation duration, and the recurrence was recorded. A 5-point visual analog scale (VAS) was used to assess patient satisfaction and whether patients would recommend thier treatment to others.

Results:

Recurrence was observed in 11 (8.3%) patients in the marsupialization group, and 12 (18.8%) patients in the Word catheter group (p=0.034). Median (range) VAS scores in the marsupialization group were better than the Word catheter group [4 (1-5) vs 3 (1-5); p<0.001].

Conclusion:

Higher recurrence rate and dissatisfaction level were found in the Word catheter group. The only advantage of using Word catheter was its short operation time. These results appear to show that marsupialization should be the first-line treatment for Bartholin cysts and abscesses. However, the small number of cases and the retrospective nature of this study mean that larger, prospective studies are required to support this hypothesis.

Bartholin Gland Abscess Diagnosis and Office Management

While Bartholin gland abscesses are less commonly seen outpatient pathology, prompt diagnosis and treatment are essential to preventing serious complications such as sepsis and rectovaginal fistula. Owing to an unacceptably high recurrence rate, simple incision and drainage is insufficient for primary treatment; preferably, placement of a Word catheter or Jacobi ring device to reepithelize the duct may be done under local anesthesia in an outpatient clinic. Destruction of the gland through silver nitrate application or alcohol sclerotherapy is an alternative. Marsupialization is often reserved for recurrent cases, although can be offered as primary management in some situations.

Approach to Bartholin's abscesses and recurrences under office conditions

OBJECTIVE

The aim of this study is to investigate the various treatment methods and recurrence rates regarding Bartholin's gland abscesses under office conditions in our clinic.

METHODS

In our study, the data of 155 patients who applied to the gynaecology and obstetrics clinic of our hospital between January 2017 and November 2020 and had Bartholin's abscess that was treated with surgical methods under office conditions were analyzed retrospectively.

RESULTS

Of the 155 patients included in the study, 111 underwent incision drainage, 22 underwent marsupialization, and 22 underwent incision drainage+ silver nitrate. Bartholin's abscess was localized on the right side in 48.4% of the patients and on the left side in 51.6% of the patients. Recurrence was detected in 53 of 155 patients included. Recurrence was detected in 39.6% of the patients who underwent incision drainage in the first treatment, 31.8% of those who underwent marsupialization, and 9.1% of those who underwent incision+silver nitrate. The difference in success, based on recurrence rates, was found to be statistically significantly in favour of silver nitrate (p<0.05). In secondary treatments for recurrent cases, marsupialization or incision+silver nitrate treatment was effective in over 90% of cases, while incision drainage was effective in 30% of patients.

CONCLUSION

The findings of our study show that silver nitrate application led to a lower recurrence rate than the other two methods. In view of this, we recommend that marsupialization or silver nitrate be preferred, especially in the treatment of recurrent cases.

Surgical Treatment of Bartholin's Gland Abscess: Is Word Catheter Superior to Marsupialization?

STUDY OBJECTIVE

Bartholin's gland abscess may occur in up to 2% of the women. Surgical drainage using the Word catheter application or marsupialization is the treatment of choice in the management of Bartholin's gland abscess. We aimed to compare the abscess recurrence rates between these 2 surgical methods.

DESIGN

A retrospective cohort database study.

SETTING

A university-affiliated, high-volume teaching hospital in southern Israel.

PATIENTS

All women who were surgically treated for Bartholin's gland abscess.

INTERVENTIONS

Different clinical and postoperative characteristics were retrieved from the patients' records. A univariate analysis was conducted, and p <.05 was considered significant.

MEASUREMENTS AND MAIN RESULTS

During the study period, 321 women were admitted to our center with Bartholin's gland abscess and were managed surgically. Of these, 215 (67%) were treated using the Word catheter and 106 (33%) by drainage and marsupialization. No differences were found in clinical and microbiologic features between the study groups. In addition, recurrence rates as well as recurrent admissions did not differ significantly. Postoperative complications were similar between the groups.

CONCLUSION

Our study reassures that both the Word catheter application and marsupialization are appropriate and safe when treating Bartholin's gland abscess.

Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians

BACKGROUND

Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses.

OBJECTIVE

This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department.

DISCUSSION

Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative.

CONCLUSIONS

This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.

[Antibiotics in first-line in case of bartholinitis: Retrospective Study of 33 Cases]

OBJECTIVES

Acute Bartholinitis is a common pathology affecting nearly 2% of women in their lifetime. Many treatments are used, although their effectiveness is not demonstrated in the literature. The main objective was to evaluate the success rate of first-line antibiotic therapy. The secondary objective was to identify factors associated with successful treatment.

METHODS

We conducted a retrospective unicentric study between January 2014 and June 2018 at the University Hospital Center of Nancy. Inclusion criteria were the presence of acute bartholinitis treated with first-line antibiotic therapy. Exclusion criteria were patients lost to follow-up after initiation of treatment. The primary endpoint was the absence of surgical treatment within 30 days of initiation of antibiotic therapy. Factors associated with successful medical treatment were sought.

RESULTS

Thirty-three patients were included. The success rate of medical treatment was 48.5% at 30 days. In the case of symptoms that had been evolving for less than 3 days, the success of medical treatment was more frequent (75% vs. 35.3%, P=0.02). Medical treatment was more effective in lesions of less than 2cm (68.7% vs. 23.5%, P=0.01). After adjustment, the only factor associated with successful medical treatment was lesion size≤2cm [ORa=5.31 (1.05-26.81)].

CONCLUSION

First-line antibiotic therapy for acute bartholinitis seems effective but should be targeted according to certain eligibility criteria.

Word Catheter Placement for Bartholin's Gland Abscess: Applications for Clinical Practice and Simulation

For women who present with Bartholin's abscesses, placement of a Word catheter offers a minimally invasive approach for effective management in urgent care and emergency department settings. Although the procedure is relatively simple, the frequency of placement in the ED setting varies. Provider familiarity with both the device and the procedure can be enhanced using simulation techniques. This article presents the diagnostic and treatment approaches to Bartholin's abscesses and describes in detail both low- and high-fidelity simulations for Word catheter placements.

Bartholin's gland abscess in a prepubertal female: A case report

Bartholin's gland abscess is one of the common inflictions of vulva seen in females of reproductive age group with a recurrence rate of up to 38%. Although it's encountered by many Paediatric Surgeons, it's very rarely reported in prepubertal age. Till date, only six cases have been reported to the best of our knowledge.

A seven-year-old female child presented with a recurrent labial abscess. She was found to have Bartholin's gland abscess and was treated with partial excision of cyst wall along with the overlying mucosa and drainage. There has been no recurrence for the past six months at follow-up.

Bartholin's gland abscess, although rare in children, should be considered as one of the differential diagnosis of a labial swelling. Adequate drainage is essential to prevent recurrence.

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Bartholin's gland abscess, although rare in children, should be considered as one of the differential diagnosis of a labial swelling.

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It has a recurrence rate of up to 38%.

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Its notorious nature of recurrence can be prevented by partial excision of the cyst wall, incision and curettage, marsupialization, or placement of a word catheter or a rubber drain.

Costing evidence for health care decision-making in Austria: A systematic review

BACKGROUND

With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development.

METHODS

A systematic literature review of English and German language peer-reviewed as well as grey literature (2004-2015) was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed.

RESULTS

A total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs.

CONCLUSION

There are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific methodological guidance and a national reference cost library should be set up to allow harmonisation of valuation methods.

Bartholin gland abscess during pregnancy: Report on 40 patients

OBJECTIVE(S)

To study the clinical and bacterial characteristic of Bartholin gland abscesses during pregnancy and the obstetric and neonatal outcomes.

STUDY DESIGN

Retrospective cohort study of all patients with surgical treatment of Bartholin gland abscesses between 2004 and 2015 in our university center. Clinical and bacterial characteristics between pregnant and non-pregnant women were compared.

RESULTS

During the period study, 156 patients were included (40 pregnant and 116 non pregnant). The incidence of Bartholin gland abscesses during pregnancy was 0.13%. Eight (20%) abscesses occurred in the first, 18 (45%) in the second, 11 (47.5%) in the third trimester and 3 (7.5%) in the post-partum course. No severe perineal and neonatal infections occurred during pregnancy. One late miscarriage and one preterm delivery were observed. We found more multiparity in the pregnant woman group than in non-pregnant women (62.5% versus 45%, p<0.05). A history of Bartholin gland abscesses were also more frequent in pregnant women (55% versus 30.1%, p<0.05). First line antibiotic therapy was more frequent in non-pregnant women (20% versus 45%, p<0.05). The rate of positive culture did not differ between the two groups (70% versus 55.2%). Among negative pus cultures, no patient in the pregnant woman group had received a first line antibiotic therapy, in contrast with non-pregnant women (0% versus 25%, p<0.05). E. coli was the most common pathogen in the two groups (48.9% of positive cultures and 28.2% of the overall population). The distribution of bacterial taxa was not different between the two groups.

CONCLUSION

Bacterial characteristics did not differ from non-pregnant women. Pregnancy could increase the occurrence of Bartholin gland abscesses in patients with previous surgical treatment of abscesses. When appropriate management is applied, maternal and neonatal outcomes are favorable, and severe infections are not to be expected.

Word balloon catheter for Bartholin's cyst and abscess as an office procedure: clinical time gained

BACKGROUND

Around 2% of women develop a Bartholin's cyst or abscess at least once in their life time. The use of Word balloon catheter as an office procedure for the management of Bartholin's cyst and abscess has been well described and indicates high patient acceptance, low short-term recurrence rates and reduced cost. In most of the reported studies, the reduced costs are attributed to savings from equipment cost, operating theatre costs and health personnel costs. An evaluation of the actual clinical time gained with this office procedure has not been reported and hence the rationale for this study. This study was conducted from December 2011 to January 2014 on 35 patients. An initial retrospective clinical audit of 14 cases of marsupialization under general anesthetic between December 2011 and December 2012 was performed. The findings were compared with a subsequent prospective observational service evaluation of 21 consecutive patients between December 2012 and January 2014.

RESULTS

Compared to marsupialization under general anesthetic, the mean clinical time gained from admission to insertion of Word balloon catheter as an office procedure is 15 h and 40 min and the mean clinical time gained from admission to discharge is at least 24 h. There were very few minor complications and no major complications in the Word catheter group compared to the marsupialization group.

CONCLUSIONS

There is a clinically significant time gained with the use of Word balloon catheter as an office procedure compared to marsupialization under general anesthetic for Bartholin's cyst and abscess. The findings from our study could assist other units that want to adopt this procedure justify the efficiency savings in terms of clinical time gained when a business case is submitted. Further studies are needed to investigate and address the underlying causes for the delays encountered when marsupialization under general anesthetic is chosen by patients.