This first survey wave of integrated biological and behavioral surveillance system in Egypt to track the HIV epidemic among male IDUs found relatively low prevalence of infection compared to global estimates, though the figure is many times higher than the general population. In addition, risky injection practices and unprotected sex were high with sexual networks including men who have sex with men, female sex workers, wives, and other regular and casual partners. The respondent-driven sampling method was effective in recruiting male IDUs and the results are being used to inform surveillance and prevention programs.

Objective: To investigate whether patients requiring dialysis are a higher risk surgical population and would experience more peri-operative adverse events even when undergoing a perceived less invasive operation as a laparoscopic radical nephrectomy (LRN). LRN is generally a well-tolerated surgical procedure with minimal morbidity and mortality. Prior to transplantation, dialysis patients will often have to undergo a LRN to remove a native kidney with a suspicious mass. Materials and Methods: Patients in the American College of Surgeons National Surgical Quality Improvement Program who underwent a laparoscopic radical nephrectomy between 2011 and 2016 were included. Patients were stratified by the need for pre-operative dialysis two weeks prior to surgery, and peri-operative outcomes were compared. A multivariable logistic regression analysis was performed to test the association between the need for pre-operative dialysis and peri-operative risk. Results: There were 8,315 patients included in this analysis of which 445 (5.4%) patients required pre-operative dialysis. Patients who required pre-operative dialysis had more minor (p < .0001) and major (p=.0025) complications, a higher rate of return to the operating room (p=0.002), and a longer length of stay (LOS) (p < 0.0001) than those patients not requiring pre-operative dialysis. In a multivariate analysis, the need for pre-operative dialysis was independently associated with adverse peri-operative outcomes (OR=1.45, CI=1.08-1.95, p=.015). Conclusions: Patients requiring pre-operative dialysis were more likely to experience a peri-operative complication and have a longer LOS. For LRNs performed prior to transplantation, further risk stratification is needed, and treatment sequencing may need to be reconsidered.

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had severe pelvic and perineal pain. Colostomy and SP tube placement provided no resolution of his symptoms.Robotic assisted salvage prostatectomy was performed, with bladder neck reconstruction. There was a dense 2 cm transphincteric bulbomembranous urethral stricture. Colon and Rectal surgery did a robotic low anterior resection and coloanal anastomosis. A perineal, posterior urethroplasty was performed with stricture excision and urethral mobilization. The urethra was reintroduced intraperitoneally and traditional robotic urethrovesical anastomosis performed. A gracilis muscle interposition flap was placed between the suture lines. The case took 14h.RESULTS: At 6 months, the patient had no fistula recurrence. His perineal pain resolved. His colostomy was reversed, restoring fecal continuity. As expected, he had total incontinence managed with interval placement of a transcorporal artificial urinary sphincter.CONCLUSIONS: When there is a clinical suspicion that highly complex radiation RUF might fail traditional perineal repair, a multidisciplinary approach combining a robotic abdominal salvage prostatectomy, perineal urethroplasty and rectal fistula closure affords restoration of continuity of both the fecal and urinary streams. For the appropriate patient, this avoids permanent dual diversion and, though surgically challenging, may be attractive. A series is ongoing.