Ureteral retrograde brush biopsy

How the Test is Performed

This procedure is performed using regional (spinal) or general anesthesia. The test takes about 30 - 60 minutes.

A tube with a camera on the end (cystoscope) is first placed through the urethra into the bladder. Then a guide wire is inserted through the cystoscope into the ureter (the tube between the bladder and kidney).

The cystoscope is removed, leaving the guide wire in place. A longer, thinner telescope (ureteroscope) with a small camera is then inserted over or next to the guide wire to see the inside of the ureter or kidney.

A nylon or steel brush is placed through the ureteroscope. The suspicious area 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 and sent to a pathology laboratory for analysis. The instrument and guide wire are removed from the body. Sometimes a small tube or stent is temporarily left in the ureter to prevent a kidney blockage caused by swelling from the procedure.

How to Prepare for the Test

You will probably need to fast for about 6 hours. Your health care provider will tell you how you need to prepare.

How the Test Will Feel

After the test is over, you may have some mild cramping or discomfort. Some burning may occur the first few times you empty your bladder. You may also see some blood in your urine for a few days after the procedure.

Why the Test is Performed

This test is used to take a sample of tissue from the kidney (renal pelvis or calyx) or ureter. It is performed when an x-ray or other test has shown a suspicious area (lesion), or there are suspicious cells in the urine.

Normal Results

The tissue appears normal.

What Abnormal Results Mean

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

Risks

• Allergy to anesthesia
• Bleeding
• Hole (perforation) in the ureter
• Infection (urinary tract infection, pyelonephritis, or sepsis)

Tell your health care provider if you have an allergy to seafood -- it may cause an allergic reaction if the contrast dye used during this test is given through a vein (intravenous line).

Considerations

This test should not be performed in people with a urinary tract infection or a blockage at or below the biopsy site.

After the test, watch for abdominal pain or flank pain. Report excess pain, fever, or chills to your health care provider right away.

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 three emptyings of the bladder to your health care provider.

Alternative Names

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

References

Sagalowsky AI, Jarrett TW, Flanigan RC. Urothelial tumors of the upper urinary tract and ureter. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 49.

Update Date: 6/18/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.