The Use of Pulsed Radiofrequency for the Treatment of Pudendal Neuralgia: A Case Series.

OBJECTIVE: Pudendal neuralgia is a recognized cause of chronic pelvic pain. The diagnosis is complex, and there is no consensus on ideal management. Many current methods do not provide adequate relief. Pulsed radiofrequency is a minimally invasive option that has been reported for its use in other neuropathies. This study aimed to evaluate the feasibility and safety of using transvaginal pulsed radiofrequency for the treatment of pudendal neuralgia and to generate a hypothesis on its efficacy. METHODS: A retrospective review was conducted of women who were treated with pulsed radiofrequency for chronic pelvic pain owing to pudendal neuralgia between January 2012 and December 2017 at an academic tertiary care centre. (Canadian Task Force Classification II-3). RESULTS: A total of seven patients were included. The mean age was 43.7 (standard deviation 7.97). The average number of pulsed radiofrequency treatments was 4.43 (range 1-12), and the duration of effect averaged 11.4 weeks (standard deviation 3.09). There were no major or minor complications at the time of procedure or at follow-up visits. CONCLUSIONS: Pulsed radiofrequency may be an effective and safe treatment option for the management of pudendal neuralgia for women in whom conservative management has not been effective. Future controlled studies are needed to confirm this hypothesis.

Infants Born Large for Gestational Age and Developmental Attainment in Early Childhood.

OBJECTIVES: To investigate if an association exists between being born large for gestational age (LGA) and verbal ability or externalizing behaviour problems at ages 4-5 years. METHOD: A secondary analysis was conducted using the National Longitudinal Survey of Children and Youth, including singleton births in 2004-2005 followed till 4-5 years (n = 1685). LGA was defined as a birth weight > 90th percentile. Outcomes included poor verbal ability (scoring < 15th percentile on the Revised Peabody Picture Vocabulary Test) and externalizing behaviour problems (scoring > 90th percentile on externalizing behaviour scales). Multivariable logistic regression with longitudinal standardized funnel weights and bootstrapping estimation were used. RESULTS: Infants born LGA were not found to be at increased risk for poor verbal ability (aOR: 1.16 [0.49,2.72] and aOR: 0.83 [0.37,1.87] for girls and boys, resp.) or externalizing behaviour problems (aOR: 1.24 [0.52,2.93] and aOR: 1.24 [0.66,2.36] for girls and boys, resp.). Social factors were found to impact developmental attainment. Maternal smoking led to an increased risk for externalizing behaviour problems (aOR: 3.33 [1.60,6.94] and aOR: 2.12 [1.09,4.13] for girls and boys, resp.). CONCLUSION: There is no evidence to suggest that infants born LGA are at increased risk for poor verbal ability or externalizing behaviour problems.