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Prospective Randomized Study of Marsupialization versus Silver Nitrate Application in the Management of Bartholin Gland Cysts and Abscesses.

STUDY OBJECTIVE: To prospectively compare the efficacy of marsupialization or silver nitrate application in the treatment of Bartholin gland cysts abscesses, both of which are widely used as outpatient procedures.

DESIGN: Prospective randomized trial. Design classification I.

SETTING: Teaching and research hospital, a tertiary center.

PATIENTS: A total of 212 patients admitted to our gynecology clinic with symptomatic Bartholin gland cysts/abscesses.

INTERVENTIONS: Marsupialization and silver nitrate application in Bartholin gland cysts/abscesses.

MEASUREMENTS AND MAIN RESULTS: In all, the 212 patients were randomly allocated to either marsupialization (group I) or silver nitrate application (group II) from March 2005 through March 2007. A total of 159 women were eligible for reevaluation at the end of the sixth month. In all, 83 were randomized to group I and 76 to group II. The patients were called for revisits at day 3, day 7, month 1, and month 6 of treatment. The 2 groups were compared for recurrence rates as primary outcome and duration of procedures, complications, size of scar tissues, and presence of dyspareunia as secondary outcomes. Comparisons of 2 groups were evaluated by Pearson X(2) test and Mann-Whitney U test, as appropriate. The 2 groups were comparable with regard to age, parity, and diameter of cyst or abscess. The recurrence rates were similar: 24.1% in group I and 26.3% in group II at 6 months (p =.67). No statistically significant differences were found in respect to duration of procedures or presence of dyspareunia. Complete healing without scar formation was observed in 31.3% and 55.7% of patients in groups I and II, respectively, and this was statistically significant (p =.007).

CONCLUSION: Marsupialization and silver nitrate application seem to be equally effective management methods in Bartholin cyst and abscesses, however, silver nitrate favors complete healing with less scar formation.

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