Incidental bartholin gland cysts identified on pelvic magnetic resonance imaging

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.

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.

Evaluation of treatments for Bartholin's cyst or abscess: a systematic review

BACKGROUND

No consensus on the management of symptomatic cysts or abscesses of the Bartholin's gland exists.

OBJECTIVES

To assess the effectiveness and safety of surgical interventions for a symptomatic Bartholin's cyst or abscess.

SEARCH STRATEGY

We searched bibliographical databases from inception to April 2019.

SELECTION CRITERIA

Randomised trials evaluating a surgical intervention for the treatment of a symptomatic Bartholin's cyst or abscess.

DATA COLLECTION AND ANALYSIS

Eight trials, reporting data from 699 women, were included. Study characteristics and methodological quality were recorded for each trial. Summary estimates were calculated using random-effects methods.

MAIN RESULTS

When considering the recurrence of a symptomatic Bartholin's cyst or abscess, the evidence was consistent with notable effects in either direction (risk ratio [RR] 0.76; 95% confidence interval [CI] 0.41-1.40) when comparing marsupialisation with incision, drainage and insertion of a Word catheter. Limited inference could be made when comparing marsupialisation with incision, drainage and silver nitrate insertion (RR 1.00; 95% CI 0.57-1.75), and incision, drainage and cavity closure (RR 0.25; 95% CI 0.01-4.89). There was limited reporting of secondary outcomes, including haematoma, infectious morbidity and persistent dyspareunia.

CONCLUSIONS

Current randomised trial evidence does not support the use of any single surgical intervention for the treatment of a symptomatic cyst or abscess of the Bartholin's gland.

PROSPECTIVE REGISTRATION

PROSPERO: International Prospective Register of Systematic Reviews; CRD42018088553.

TWEETABLE ABSTRACT

Further research is needed to identify an effective treatment for #Bartholin's cyst or abscess. @jamesmnduffy.

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.

A Report of Two Cases of "Giant Bartholin Gland Cysts" Successfully Treated by Excision with Review of Literature

Bartholin's gland cysts are one of the common vulval masses that may start as asymptomatic cysts but if left untreated, may become large and infected requiring medical attention. We are presenting two interesting and rare cases of giant Bartholin cyst and their treatment in this case report. Two female patients of perimenopausal age presented with giant vulval cysts to the outpatient department of Obstetrics and Gynaecology. They reached a size of 10 cm and 20 cm diameter respectively, presenting with some diagnostic and later reconstruction of the labia majus. MRI pelvis provided good information regarding the size, shape and extent of the cyst, which was very useful during surgery. Both these cases were successfully treated by excision of the cyst and histopathological examination after complete excision. One of the cases presented as dumb-bell shaped swelling with large cyst superiorly and smaller cyst extending into the buttock connected by narrow neck and showed cross fluctuation. This type of dumb-bell shaped presentation of Bartholin's cyst is rather unusual and has not been reported in the available literature.

Asymptomatic Bartholin Cyst: Evaluation With Multidetector Row Computed Tomography

OBJECTIVE

The aim of this study was to determine the frequency, morphology, and attenuation characteristics of Bartholin cysts on multidetector computed tomography (MDCT) in asymptomatic women.

METHODS

A total of 3280 consecutive MDCT examinations were assessed for Bartholin cysts. The diagnosis was based on shape, contrast enhancement, and anatomical location. Age, laterality, size, and attenuation patterns were recorded. Scans from patients with paravaginal-related symptoms were excluded, and any available follow-up MDCT scans or magnetic resonance images were evaluated.

RESULTS

Asymptomatic Bartholin cysts were seen in 17 patients (0.52%) (mean age, 56 years). The mean maximum cyst diameter was 21.8 mm. High-attenuation cysts comprised 47% of cases, all in older (≥50 years) patients. Follow-up MDCT scans showed minimal changes over time.

CONCLUSIONS

High-attenuation Bartholin cysts are more common than previously thought and are usually seen in older women. The size and attenuation of Bartholin cysts show only minimal changes over time.

Female perineal diseases: spectrum of imaging findings

The female perineum, which is divided into the anterior urogenital triangle and the posterior anal triangle, is a surface structure often overlooked. Female perineal diseases may present with nonspecific clinical signs due to its close anatomical relationship between the different compartments. Diagnosis of the origin of a perineal disorder may also be a difficult problem encountered in pelvi-perineal imaging. Therefore, a precise knowledge of the female perineal anatomy and the associated disease processes is essential to radiologists, pathologists, and surgeons alike who are involved in the evaluation of the patient who presents with a perineal mass. Cross-sectional imaging plays a crucial role for proper management. Due to the robust contrast resolution of MR, MR imaging is the modality of choice for evaluation of the extent of a complex perineal lesion, its relationship to the adjacent structures. It has a greater sensitivity and specificity for the diagnosis than the other non-invasive imaging techniques and is helpful in guidance for surgical planning. The purpose of this article is to highlight the spectrum of imaging findings of female perineal diseases.

Clinical Pathology of Bartholin's Glands: A Review of the Literature

The Bartholin's glands are located symmetrically at the posterior region of the vaginal opening and play an important role in the female reproductive system. These two pea-sized glands are involved in mucus secretion and vaginal lubrication. Cyst formation in the glands is common and results from mucus build-up in gland ducts. It is important to monitor such cysts because they may occur in the form of carcinomas. Larger cysts and abscesses are found in the lower vestibular region and typically present with erythema and edema. Biopsy is an effective method for distinguishing between Bartholin's gland cysts and differential diagnosis. While smaller cysts may be asymptomatic and may be left untreated, larger cysts require medical attention. Several treatment options are available, including marsupialization and CO2 laser. Healing and recovery depend on the severity of infection and course of treatment.