Aims Pelvic floor muscle trauma and pudendal nerve injury have been implicated in stress urinary incontinence (SUI) development after childbirth. In this study, we investigated how combinations of these injuries affect recovery. Methods Sixty-seven female Sprague-Dawley rats underwent vaginal distension (VD), pudendal nerve crush (PNC), PNC and VD (PNC+VD), pudendal nerve transection (PNT), or served as unmanipulated controls. Four days, 3 weeks, or 6 weeks after injury, we simultaneously recorded pudendal nerve motor branch potentials (PNMBP), external urethral sphincter electromyography (EUS EMG), and transurethral bladder pressure under urethane anesthesia. The presence of a guarding reflex (increased frequency & amplitude of PNMBP or EUS EMG activity) during leak point pressure (LPP) testing was determined. Results Controls consistently demonstrated a guarding reflex. Four days after VD, EUS EMG activity was eliminated, but PNMBP activity reflected the guarding reflex; EUS EMG activity recovered after 3 weeks. Four days after PNC, both EUS EMG and PNMBP activity were eliminated, but demonstrated significant recovery at 3 weeks. Four days after PNC+VD both EUS EMG and nerve activity were eliminated, and little recovery was observed after 3 weeks with significant recovery of the guarding reflex 6 weeks after injury. Little recovery was observed at all time points after PNT. LPP results mirrored the reduction in EUS EMG activity. Conclusion Functional recovery occurs more slowly after PNC+VD than after either PNC or VD alone. Future work will be aimed at testing methods to facilitate neuroregeneration and recovery after this clinically relevant dual injury.

Lymphogranuloma venereum is a sexually transmitted infection caused by serotypes L1-3 of Chlamydia trachomatis and may present as hemorrhagic proctocolitis. The diagnosis of an active infection is difficult to establish, as confirmatory testing can be unreliable or unavailable. Imaging findings can be nonspecific and mimic malignancy or other chronic infectious and inflammatory disorders. In this report, we present a case of lymphogranuloma venereum proctocolitis and its computed tomography features to highlight the relevant imaging findings and importance of timely diagnosis.

Objectives Intussusception is the most common abdominal emergency in pediatric patients aged 6 months to 3 years. There is often a delay in diagnosis, as the presentation can be confused for viral gastroenteritis. Given this scenario, we questioned the practice of performing emergency reductions in children during the night when minimal support staff are available. Pneumatic reduction is not a benign procedure, with the most significant risk being bowel perforation. We performed this analysis to determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are available. Methods We performed a retrospective review of intussusceptions occurring between January 2010 and May 2015 at 2 tertiary care institutions. The medical record for each patient was evaluated for age at presentation, sex, time of presentation to clinician or the emergency department, and time to reduction. The outcomes of attempted reduction were documented, as well as time to surgery and surgical findings in applicable cases. A Wilcoxon rank test was used to compare the median time with nonsurgical intervention among those who did not undergo surgery to the median time to nonsurgical intervention among those who ultimately underwent surgery for reduction. Multivariable logistic regression was used to test the association between surgical intervention and time to nonsurgical reduction, adjusting for the age of patients. Results The median time to nonsurgical intervention was higher among patients who ultimately underwent surgery than among those who did not require surgery (17.9 vs 7.0 hours; P < 0.0001). The time to nonsurgical intervention was positively associated with a higher probability of surgical intervention (P = 0.002). Conclusions Intussusception should continue to be considered an emergency, with nonsurgical reduction attempted promptly as standard of care.

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