Bartholin's cyst

Key NICE recommendations on management

Balloon catheter insertion for Bartholin’s cyst or abscess

The intervention procedural guidance is based on a rapid review of the medical literature (which included three case series; no randomised clinical trials were identified at the time of the review) and specialist opinion. The review concluded that evidence on the safety and efficacy of balloon catheter insertion for Bartholin's cyst or abscess is adequate to support the use of this procedure.

Balloon catheter insertion for Bartholin’s cyst or abscess aims to establish drainage of the abscess or cyst by inducing fistula/sinus tract formation that will stay open long-term.

• Under local or general anaesthesia, the abscess/cyst is incised and drained, the catheter inserted into the cavity, and the balloon inflated to secure it. If pain persists, the balloon is partially deflated (but left inflated enough to secure the catheter). The catheter remains usually up to 4 weeks (to allow epithelialisation of the tract) before being removed.

Efficacy and safety

Key efficacy outcomes were healing in the short term, and absence of abscess recurrence 6 months after the procedure. The following were considered theoretical adverse events: infection, abscess recurrence, bleeding, pain from having the catheter in situ, scarring, expulsion of the bulb of the catheter and dyspareunia.

• One prospective case series of 35 women with Bartholin’s abscess treated with balloon catheter reported a 97% operative success rate (defined as short-term resolution with no recurrence or need for marsupialisation). Seven premature catheter expulsions were reported. Mild post-procedure discomfort was reported by 5 women at 1-week follow-up; a further woman reported moderate post-procedure discomfort and a continuous sensation of labial swelling (which subsided on partial deflation of the balloon).

• A case series of 46 women with Bartholin’s cyst or abscess treated with balloon catheter reported a 17% recurrence rate. Success was defined as a patent duct and orifice with normal duct function at 3-month follow-up. Four premature catheter expulsions were reported. No safety data were reported by this series.

• A case series of 68 women with Bartholin’s cyst or abscess treated with balloon catheter reported two cyst recurrences at 6 months and 5 years respectively. Necrotic abscess development occurred in 1 woman and another was admitted to hospital for 9 days (both stated to be related to improper catheter insertion).

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