How the Test is Performed

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

A long, thin tube (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 small camera used to see the inside of the ureter and kidney (ureteroscope) is then inserted over or next to the guide wire.

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 completely removed from the body.

How to Prepare for the Test

Fasting for about 6 hours is generally recommended. Your health care provider will advise you on specific preparations you will need to make.

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

Tell your health care provider if you have any allergies to seafood, as these may cause allergic reactions 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 acute urinary tract infection or a blockage at or below the biopsy site.

After the test, watch for abdominal pain or flank pain. Report excessive pain, fever, or chills to your health care provider immediately.

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. Management of urothelial tumors of the renal pelvis and ureter. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 49.

Update Date: 4/11/2012

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.