Time of onset and factors associated with delayed response post intradetrusor injection of onabotulinumtoxin a in patients with neurogenic and idiopathic overactive bladder syndrome.

Objective: The objective of this study was to determine risk factors for delayed response in patients with neurogenic and idiopathic overactive bladder (OAB) after intradetrusor onabotulinumtoxin A injection. Subjects and Methods: This is a retrospective study that included 87 patients who underwent onabotulinumtoxin A intradetrusor injection from October 2011 to November 2019. Patients were followed up at 2, 4, and 12 weeks post intervention in the outpatient clinic and over the phone. The data of patients with early response were compared with those with late response using univariate and multivariate analyses. Results: The study included 87 patients. The mean age was 41 ± 15.3 standard deviation, and 69% of the participants were female. Fifty-one percent were diagnosed with neurogenic OAB. A median response time to onabotulinumtoxin A injection of 7 days was demonstrated, and patients who responded during the first 7 days post procedure were considered early responders. Independent predictors for late response include diabetes (Relative risk: 3.89, P = 0.018, and 95% confidence interval [CI]: 1.26-11.98), >1 BTX-A session (Relative risk: 4, P = 0.011, and 95% CI: 1.38-11.6), and wet OAB (RR: 9.94, P = 0.002, and 95% CI: 2.31-42.17). Conclusions: The median time of onset post intradetrusor injection of onabotulinumtoxin A was found to be 7 days. Diabetes mellitus, wet OAB, and <1 Botox sessions were independent risk factors for late onset of response.

Microaggressions: Prevalence and Perspectives of Residents and Fellows in Post-Graduate Medical Education in Kuwait.

Objective: Microaggression prevalence in post-graduate medical education is unknown in Kuwait. The objective is to determine the prevalence of and capture the perspectives on microaggression among post-graduate trainees in Kuwait. Materials and Methods: This is a cross-sectional study of an anonymous online survey targeting residents and fellows in Kuwait. Data collected included demographics, level of training, country of training, microaggression experience, types, and response. Univariate and multivariate analyses were performed using the Chi-square test and binary logistic regression, respectively. Results: A total of 319 participants (69.1% females) included 52% junior residents, 39.2% senior residents, and 8.78% fellows. Forty-three percent were aware of the microaggression definition. The percentage was significantly higher in respondents from Gulf/Middle East Countries (57.9%) than from Kuwait. Approximately three-quarters experienced microaggressions. Senior residents were more likely to report exposure to microaggressions [Odds ratio (OR) = 2.4, P < 0.05] and had higher odds of exposure than juniors (OR = 9.85, P < 0.05). Exposure to microaggressions was highest in surgery/surgical specialties. The most common act of microaggression was verbal, followed by invalidation/dismissal of thoughts/ideas, and then acts of discrimination. Of those who experienced microaggressions, two-thirds thought that the experience had a psychological effect on them. Both groups reported low confidence in dealing with microaggressions (Gulf/Middle East Countries 18.8% and Kuwait 30.1%); the difference was not statistically significant. Conclusions: Microaggressions are common among post-graduate medical trainees in Kuwait. Implementation of strategies to manage it is necessary. Further research on its impact on medical-training outcomes is needed.

Robotic pyelolithotomy in a congenital pelvic kidney: side docking and robotic prostatectomy port - site approach.

INTRODUCTION AND OBJECTIVES: Ectopic pelvic kidneys with renal stones are challenging to treat. We report our experience in managing a case of ectopic pelvic kidney with a pelvic stone by robotic pyelolithotomy after failure of flexible ureteroscopy. MATERIALS AND METHODS: A 46-year old male with 2 months history of vague lower abdominal pain was found to have on Computed Tomography scan a left ectopic pelvic kidney with a 12mm stone in an anomalous renal pelvis. Flexible ureteroscopy failed to reach the stone twice and a 4.7 French ureteric stent was placed. RESULTS: Side docking was utilized with the patient in supine Trendelenburg position. Port placements were similar to robotic assisted laparoscopic prostatectomy. Docking time was 35 minutes and console time was 150 minutes. Multiple attempts failed to follow the course of the ureter to the renal pelvis. Subsequently the renal pelvis was directly opened through the mesocolon and a flexible cystoscope was used to basket the stone out. Estimated Blood Loss was < 100ml. The patient was discharged 2 days postoperatively. CONCLUSION: Robotic pyelolithotomy is safe and feasible for management of ectopic pelvic kidneys with pelvic stones. The use of flexible cystoscopy helped in localizing and extracting the stone in our case. Detailed understanding of patient's anatomy helps in the success of this procedure.