WoMan‐Trial RCT: word catheter for the treatment of Bartholin cyst or abscess appears to be more cost effective than the conventional incision and drainage

This randomised controlled trial (RCT) by Kroese et al. tackles an interesting, common gynaecological condition of significant clinical importance. It is original work as the previous RCTs (Andersen et al. Acta Obstet Gynecol Scand 1992;71:59–62; Gennis et al. Am J Emerg Med 2005;23:414–15) were small, and not as well designed. When appropriately designed, conducted and reported, RCTs represent the reference standard in evaluating healthcare interventions. This RCT demonstrated that in women with an abscess or cyst of the Bartholin gland, treatment with Word catheter or marsupialisation resulted in comparable recurrence rates. Median time from randomisation to treatment was 3 hours shorter for Word catheter than for marsupialisation. Maximal and average pain experienced during treatment were both higher in the Word catheter group compared with marsupialisation. However, pain scores after treatment were comparable, although those women undergoing marsupialisation required more analgesia during the first postoperative day. There are obviously other confounding factors affecting the recurrence rate, such as diabetes. How did the authors address that issue and was there any trend difference in the diabetic group? In other words, in a woman with diabetes how can the authors reliably make inferences that the recurrence is method/technique-related and not attributed to her diabetes? This RCT is well designed, conducted and adequately implemented the Consolidated Standards of Reporting Trials recommendations (CONSORT) (Schulz, et al. BMJ 2010;340:c332). One of these recommendations is that the trial's results be discussed in light of the totality of the available evidence. There is explicit reference in the discussion to the results of the systematically conducted, published review of previously reported studies, explaining why the current study was justified. I agree with the authors’ statements that the strengths of this RCT are the following. This RCT also adapts the proposal by Docherty et al. (BMJ 1999; 318:1224–5) stating the main results, the strengths and limitations, interpretation/ comparison with the previous reviews/ RCTs and literature, but could have elaborated further on implication on clinical practice. The authors stated that ‘In our opinion, our data therefore favour treatment of a Bartholin cyst or abscess with a Word catheter since this is the fastest procedure, relieving pain sooner after diagnosis, with less cost than when marsupialisation is performed’; however, this was not demonstrated by running a health economy cost analysis to reveal the potential cost saving when implementing the Word catheter method. This would have factually informed the above inference made by the authors. Clearly the main potential implication is on cost, sparing beds/admissions, and saving general anaesthetic risk and theatre operative and recovery times, rendering this day-case procedure to a potentially office procedure. Readers would have appreciated provision of a picture of the Word catheter. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.