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Ureteral retrograde brush biopsy

Biopsy - brush - urinary tract; Retrograde ureteral brush biopsy cytology; Cytology - ureteral retrograde brush biopsy

 

Ureteral retrograde brush biopsy is a surgical procedure. During the surgery, your surgeon takes a small sample of tissue from the lining of the kidney or ureter. The ureter is the tube that connects a kidney to the bladder. The tissue is sent to a lab for testing.

How the Test is Performed

 

This procedure is done using:

  • Regional (spinal) anesthesia
  • General anesthesia

You will not feel any pain. The test takes about 30 to 60 minutes.

A cystoscope is first placed through the urethra into the bladder. Cystoscope is a tube with a camera on the end.

  • Then a guide wire is inserted through the cystoscope into the ureter (the tube between the bladder and kidney).
  • The cystoscope is removed. But the guide wire is left in place.
  • A ureteroscope is inserted over or next to the guide wire. The ureteroscope is a longer, thinner telescope with a small camera. The surgeon can see the inside of the ureter or kidney through the camera.
  • A nylon or steel brush is placed through the ureteroscope. The area to be biopsied is rubbed with the brush. Biopsy forceps may be used instead to collect a tissue sample.
  • The brush or biopsy forceps is removed. The tissue is taken from the instrument.

The sample is then sent to a pathology lab for analysis. The instrument and guide wire are removed from the body. A small tube or stent may be left in the ureter. This prevents a kidney blockage caused by swelling from the procedure. It is removed later.

 

How to Prepare for the Test

 

You may not be able to eat or drink anything for about 6 hours before the test. Your health care provider will tell you how you need to prepare.

 

How the Test will Feel

 

You may have some mild cramping or discomfort after the test is over. You may have a burning feeling the first few times you empty your bladder. You may also urinate more often or have some blood in your urine for a few days after the procedure. You may have discomfort from the stent that will continue to be in place until it is removed at a later time.

 

Why the Test is Performed

 

This test is used to take a sample of tissue from the kidney or ureter. It is performed when an x-ray or other test has shown a suspicious area (lesion). This can also be done if there are abnormal cells in the urine.

 

Normal Results

 

The tissue appears normal.

 

What Abnormal Results Mean

 

Abnormal results may show cancer cells (carcinoma). This test is often used to tell the difference between cancerous (malignant) and noncancerous (benign) lesions.

 

Risks

 

Risks of anesthesia and surgery in general are:

  • Reactions to medicines
  • Breathing problems
  • Bleeding, blood clots
  • Infection

Another possible risk for this procedure is a hole (perforation) in the ureter. This can cause scarring of the ureter. Tell your provider if you have an allergy to seafood. This could cause you to have an allergic reaction to the contrast dye used during this test.

 

Considerations

 

This test should not be performed in people with a:

  • Urinary tract infection
  • Blockage at or below the biopsy site

You may have abdominal pain or pain on your side (flank).

A small amount of blood in the urine is normal the first few times you urinate after the procedure. Your urine may look faintly pink. Report very bloody urine or bleeding that lasts longer than 3 emptyings of the bladder to your provider.

Call your provider if you have:

  • Pain that is bad or is not getting better
  • Fever
  • Chills
  • Very bloody urine
  • Bleeding that continues after you have emptied your bladder 3 times

 

 

References

National Institute of Diabetes and Digestive and Kidney Diseases. Cystoscopy and ureteroscopy. www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/cystoscopy-ureteroscopy/Pages/default.aspx. Accessed June 14, 2016.

Smith AK, Surena FM, Jarrett TW. Urothelial tumors of the upper urinary tract and ureter. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 58.

 
  • Kidney anatomy

    Kidney anatomy - illustration

    The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.

    Kidney anatomy

    illustration

  • Kidney - blood and urine flow

    Kidney - blood and urine flow - illustration

    This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.

    Kidney - blood and urine flow

    illustration

  • Ureteral biopsy

    Ureteral biopsy - illustration

    The cystoscope enters through the urethra, then the bladder, in order for the guidewire to gain access to the ureter.

    Ureteral biopsy

    illustration

    • Kidney anatomy

      Kidney anatomy - illustration

      The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.

      Kidney anatomy

      illustration

    • Kidney - blood and urine flow

      Kidney - blood and urine flow - illustration

      This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.

      Kidney - blood and urine flow

      illustration

    • Ureteral biopsy

      Ureteral biopsy - illustration

      The cystoscope enters through the urethra, then the bladder, in order for the guidewire to gain access to the ureter.

      Ureteral biopsy

      illustration

    Tests for Ureteral retrograde brush biopsy

     

     

    Review Date: 5/23/2016

    Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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