Techniques of biopsy

Bleeding parameters should be evaluated before
Percutaneous biopsies are usually guided by US with local anaesthesia
Urothelial lesions
- Biopsied with cystoscopy or through percutaneous catheters
Other lesions
- Renal masses
- Retroperitoneal masses
- Retroperitoneal lymph nodes
- Biopsied percutaneously or by open surgery

Kidney biopsy

Kidney biopsy is not performed for urological diseases but for nephrological diseases
Indications
- Glomerulonephritis
- Renal transplant evaluation
- Renal mass where non-invasive imaging is inconclusive
  - Renal masses can be diagnosed with high specificity by non-invasive imaging in most cases
Technique
- Can be acquired percutaneously or by open surgery
Complications
- Bleeding
- Tumour seeding is rare

Bladder biopsy

Cystoscopy, also called cysturethroscopy, is a procedure where a cystoscope (an endoscope) is inserted into the urethra to examine the urethra, urethral sphincter, prostate, urinary bladder, and uretral orifices. Fluid is continously irrigated into the bladder to prevent it from collapsing and reducing view. The endoscope can visualise the organs, take biopsy samples, and perform a limited number of therapeutic interventions like cauterisation. It's one of the most common procedures performed in urology.

Indications

Haematuria
Suspicion of tumour
Urinary obstruction
Recurrent UTIs
Urinary incontinence
Bladder biopsy
Placement of DJ stent

Types

Flexible cystoscope
- Takes on the shape of the urethra -> more comfortable, less pain
- Does not allow for therapeutic intervention or deeper biopsies
Rigid cystoscope
- Is not flexible and therefore more painful to use, especially for men
- Allows for therapeutic intervention and deeper biopsies
- Must be performed under general or spinal anaesthesia

Contraindications

Acute urethritis, prostatitis, epididymitis
Febrile UTI

Performing cystoscopy on a patient with urinary infection may lead to sepsis.

Technique

Disinfection of urethral area
Application of lidocaine gel
Prepare conductive or non-conductive irrigation fluid
Insert the cystourethroscope
Inspect all parts of the urethra, bladder, and ureteral orifices

Enhanced imaging

Not all bladder tumours are easily visible with the naked eye using a cystoscope (called white light cystoscopy), especially carcinomas in situ. Two techniques allow for improved detection of bladder cancer.

Photodynamic diagnosis (PDD), also called fluorescent cystoscopy, is often used, where a fluorescent dye (photosensitiser) called hexyl aminolevulinate (HAL, Hexvix®) is administered into the bladder before the procedure. Cancer cells absorb this dye and glow red or pink when special fluorescent light is shone from the cystoscope, making them easier to see.

Narrow band imaging (NBI) is a similar technique which uses a specific wavelength of light with makes blood vessels more visible. As tumours often are hypervascularised, this can help detect tumours. No photosensitiser is required.

Prostate biopsy

Cystoscopy, also called cysturethroscopy, is a procedure where a cystoscope (an endoscope) is inserted into the urethra to examine the urethra, urethral sphincter, prostate, urinary bladder, and uretral orifices. Fluid is continously irrigated into the bladder to prevent it from collapsing and reducing view. The endoscope can visualise the organs, take biopsy samples, and perform a limited number of therapeutic interventions like cauterisation. It's one of the most common procedures performed in urology.