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Ureteroscopic Biopsy
What is
Ureteroscopic Biopsy?
Ureteroscopic biopsy is a procedure in which the
cystoscope enters through the urethra, then the
bladder, in order for the guidewire to gain
access to the ureter.
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Effects
of Ureteroscopic Biopsy
Ureteroscopic biopsy is safe and accurate if
sufficient tissue sample is obtained. Biopsy can
actually grade tumor, but not provide staging.
Ureteroscopic biopsy of upper tract lesions
allows for histological examination of tissue
samples and improves diagnostic accuracy over
that of brushing techniques.
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Candidates for Ureteroscopic Biopsy
Ureteroscopic biopsy should be performed in
patients who require nephron-sparing management.
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Your Consultation
A
thorough history and physical examination are
essential before ureteroscopy to identify any
premorbid factors that might complicate the
procedure. The presence of obstructive voiding
symptoms in an older man suggestive of prostatic
enlargement might make access to the ureteral
orifice difficult. A previous history of
ureteral reimplantation, open uteteral surgery,
or pelvic irradiation might preclude a
successful outcome with ureteroscopy. In
patients with musculoskeletal deformities of the
bony pelvis and hips, proper positioning for
ureteroscopy may be impossible.
Before ureteroscopy, any urinary tract infection
must be treated with an adequate course of
antibiotics. In addition, a single intravenous
dose of an aminoglycoside or broad-spectrum
cephalosporin is given preoperatively.
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The
Ureteroscopic Biopsy Procedure
Because ureteroscopically obtained samples are
small, techniques for handling and processing
samples are crucial. Biopsy of suspicious
lesions inside the ureter requires the forceps
to the applied parallel to the ureteral mucosa.
Biopsy is performed during the first pass of the
ureteroscope. The lesion may get traumatized or
inadvertently avulsed during the initial passage
if any attempt is made to examine the entire
upper tract and then biopsy. When the lesion is
identified, the No.3 or 5F cup forceps is
carefully advanced with its jaws parallel to the
ureter wall. The intraluminal portion of the
lesion is then grasped with the jaws and pulled
free from the ureter using gentle traction on
the forceps. A potential problem is losing the
biopsy specimen as it is pulled through the
instrument sheath. To avoid this problem, either
the telescope is removed first, thus providing
more room within the sheath or the entire scope
is removed including the forceps.
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Recovery
After
the test, watch for abdominal pain, flank pain,
or blood in the urine. A small amount of pink
color is normal the first few times you urinate
after the procedure, but grossly bloody urine or
bleeding that lasts longer than three times
urinating is significant.
Excessive pain, bleeding, fever, and/or chills
should be reported immediately to your health
care provider.
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Risks
Frequently Asked Questions
Q:
What is the ureter?
A:
Ureter is a narrow muscular cylindrical tube
lying in the retroperitoneal space, extends from
the UPJ above to the ureteral orifice below. In
adults its length varies from 24 to 30 cm. It
performs the task of transporting urine from the
kidney to the bladder.
Q:
What is a cystoscopy?
A:
Cystoscopy is an
important test for finding urinary cancers. A
cystoscope is a tool for looking inside the
bladder and ureters. The cystoscope is a narrow
tube, about the size of a pencil. It has a tiny
camera in the end that sends pictures to a TV
for the doctor to look at. The cystoscope is
passed through the urethra, starting where urine
comes out, and into the lower part of the
bladder. This is not usually painful, but a
numbing gel can be used if needed. The doctor
can look at the lining of the bladder and up
into the ureters for any signs of tumors. If any
abnormal tissue is seen, samples can be taken
out through the cystoscope. Urine is also
collected to look for cancer cells. Small pieces
of tissue are taken from normal-looking areas
inside the bladder and ureters. These are looked
at for possible early or precancerous changes in
the cells. If many tissue samples (biopsies) are
going to be taken, or if tumors are found that
need to be removed, then this procedure will be
done under general anesthesia in an operating
room.
Q:
What are the possible outcomes from a biopsy?
A:
If a
small tumor is seen in the lining of the
bladder, ureter, or renal pelvis during
cystoscopy, the doctor can remove the whole
thing. When the biopsy removes the whole tumor,
it is called an excisional biopsy. All the
tissue is looked at by a pathologist, who can
make a diagnosis and tell how far into the
bladder lining the tumor has grown.
If the biopsy shows cancer, the patient can have
tests to tell how much cancer there is and
whether or not it has spread beyond the lining
tissue.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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