Is a catheter, specifically a Word catheter, left in place after marsupialization for a Bartholin's cyst?

Marsupialization vs. Word Catheter for Bartholin's Cyst

No, a catheter is not left in place after marsupialization—marsupialization creates a permanent opening by suturing the cyst wall edges to the surrounding skin, eliminating the need for any indwelling device. This is fundamentally different from Word catheter placement, where a small inflatable catheter remains in situ for 4 weeks to allow epithelialization of a drainage tract 1, 2.

Key Procedural Differences

Marsupialization Technique

• Creates a permanent opening by incising the cyst and suturing the cyst wall edges to the vestibular skin, forming a pouch-like structure 1, 3
• No device remains in place after the procedure is completed 1
• Requires operating room time with general or regional anesthesia in most cases 2
• Average procedure time is approximately 4 hours from diagnosis to completion 1

Word Catheter Technique

• Requires catheter retention for 4 weeks to allow epithelialization of the drainage tract 1, 2
• The small inflatable catheter (with a balloon tip) is inserted through a stab incision and remains in the cyst cavity 2, 4
• Can be performed under local anesthesia in outpatient settings 2
• Average time from diagnosis to treatment is 1 hour 1

Recurrence Rates: Evidence is Mixed

The most recent high-quality randomized trial (2017) found comparable recurrence rates between both techniques:

• Word catheter: 12% recurrence at 1 year 1
• Marsupialization: 10% recurrence at 1 year 1

However, a 2022 retrospective cohort study showed higher recurrence with Word catheter:

• Word catheter: 18.8% recurrence 3
• Marsupialization: 8.3% recurrence 3

Patient Satisfaction and Practical Considerations

Marsupialization demonstrates superior patient satisfaction despite requiring more operative time:

• Higher satisfaction scores on visual analog scale compared to Word catheter 3
• 89% of Word catheter patients would choose the same treatment again 2
• Word catheter patients report significantly less analgesic use in the first 24 hours (33% vs. 74% for marsupialization) 1

Common Pitfalls with Word Catheter

• Premature catheter dislodgement occurs in approximately 20-23% of cases, typically within the first week 2
• Three catheters falling out within 24 hours, three within one week, and one after 11 days were reported in one series 2
• When the catheter falls out prematurely, epithelialization is incomplete and recurrence risk increases 4

Clinical Decision Algorithm

Choose marsupialization when:

• Operating room access is readily available 1
• Patient can tolerate general/regional anesthesia 2
• Lower recurrence rate is the priority 3
• Patient desires definitive single-stage treatment 3

Choose Word catheter when:

• Outpatient/office-based treatment is preferred 2
• Patient cannot tolerate general anesthesia 2
• Rapid treatment (within 1 hour) is needed 1
• Patient accepts the 4-week catheter retention period and potential for dislodgement 2

Sexual Activity Considerations

Patients with Word catheter can resume intercourse as early as the second week without significant discomfort, as reported by patients who engaged in intercourse during catheter retention 2. This is not typically discussed but represents a quality-of-life consideration for counseling patients.