Metastatic vesical tumors are rare, and constitute approximately 1% of all neoplasias affecting this organ. The authors report the case of a 63-year old woman with vesical metastasis of gastric adenocarcinoma. Patient presented signs of cachexia and complained of left lumbar pain and dysuria unresponsive to antibiotic therapy for approximately 5 months. She reported a previous partial gastrectomy due to ulcerative undifferentiated gastric adenocarcinoma 1 year and 9 months before. Cystoscopy revealed an extensive vegetative lesion in bladder, occupying its entire mucosal surface. The biopsy revealed metastatic signet-ring cell adenocarcinoma.

OBJECTIVE: To determine the efficacy of intrarectal lidocaine hydrochloride gel in reducing pain in patients undergoing transrectal prostate biopsy. MATERIALS AND METHODS: During the period from June to Noviber 2002, 72 patients undergoing transrectal prostate biopsy at an outpatient service were prospectively randomized. Patients were divided into 2 groups. In group 1, 20 mL of 2% lidocaine gel were administered by intrarectal route 15 minutes before biopsy. In group 2 (placebo), 20 mL of ultrasound gel were administered under the same conditions. At the end of the procedure, patients were asked to classify the discomfort degree observed during the procedure through a verbal pain scale. Statistical analysis was performed through qui-square test. RESULTS: The majority of patients in both groups presented slight pain on the examination, and 26 patients (76.4%) from group 1, and 26 (68.3%) patients from group 2 reported slight pain or no pain at all (p > 0.05). Moderate or intense pain was felt by 23.4% of patients in group 1 and 31.5% of patients in group 2 (p > 0.05). CONCLUSIONS: We concluded that lidocaine probably exerts a minimal effect on patients’ tolerance to pain on transrectal prostate biopsy.

Spontaneous renal fistula to the skin is rare. The majority of cases develop in patients with antecedents of previous renal surgery, renal trauma, renal tumors, and chronic urinary tract infection with abscess formation. We report the case of a 62-year old woman, who complained of urine leakage through the skin in the lumbar region for 2 years. She underwent a fistulography that revealed drainage of contrast agent to the collecting system and images suggesting renal lithiasis on this side. The patient underwent simple nephrectomy on this side and evolved without intercurrences in the post-operative period. Currently, the occurrence of spontaneous renal and perirenal abscesses is extremely rare, except in patients with diabetes, neoplasias and immunodepression in general.

OBJETIVO: determinar a prevalência de coilocitose em biópsias penianas de parceiros de mulheres com lesões genitais induzidas pelo HPV e analisar os fatores de risco envolvidos com a infecção peniana. MÉTODOS: foram incluídos neste estudo de coorte transversal 80 parceiros de mulheres com lesões induzidas pelo HPV no período de maio de 2002 a junho de 2003. A média de idade dos pacientes foi de 34,1 anos (variando de 16 a 63). Todos os pacientes negavam ou desconheciam qualquer tipo de lesão genital. Foram submetidos à anamnese específica quanto a presença de sintomas uretrais, passado de doenças sexualmente transmissíveis (DST), número de parceiras sexuais, uso de preservativos e postectomia. Posteriormente foram submetidos à peniscopia com a utilização de soluções de ácido acético e azul de toluidina, tendo sido colhido material para biópsia das lesões de aspecto morfológico sugestivo de contaminação por HPV. A análise estatística foi realizada pelo teste do chi2. RESULTADOS: o exame foi considerado negativo em 24 pacientes (30%). Todos os outros 56 pacientes (70%) apresentaram lesões acetobrancas e azul de toluidina positivas. Destes, 53 foram biopsiados, e 41 pacientes (77,3%) apresentaram biópsia com alterações histológicas sugestivas de infecção pelo HPV. CONCLUSÕES: a prevalência da infecção genital masculina pelo HPV foi de 51,2%, e nenhum fator de risco analisado foi associado com uma maior prevalência da infecção genital pelo vírus.

PURPOSE: to determine the prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions, and to analyze the risk factors associated with the penile viral infection. METHODS: a total of 80 partners of HPV-infected women with genital lesions were included in this transversal cohort study. The study was carried out between May 2002 and June 2003. The mean age was 34.1 years (16 to 63). No patient reported any kind of genital lesion. They answered questions regarding the presence of urethral symptoms, history of sexually transmitted diseases, number of sexual partners, use of condoms, and circumcision. The patients were submitted to peniscopy with acetic acid and toluidine blue solutions and finally to biopsy of the suspected lesions. Data were analyzed statistically by the chi2 test. RESULTS: the examination was considered negative in 24 patients (30%). All remaining 56 patients (70%) showed white lesions and toluidine blue-positive lesions. Of these, 53 were submitted to biopsy and 41 (77.3%) presented histological changes suggestive of HPV infection. CONCLUSIONS: the prevalence of the male genital infection was 51.2% and no risk factor analyzed was associated with an increased prevalence of HPV genital infection.