Ureteral retrograde brush biopsy cytology

Alternative names
Biopsy - brush - urinary tract; Retrograde ureteral brush biopsy cytology


Ureteral retrograde brush biopsy cytology is a diagnostic procedure in which tissue from the kidney or ureter (tube that connects a kidney to the bladder) is removed for examination.

How the test is performed

This procedure is performed using regional (spinal) or general anesthesia. The test will take about 30 to 60 minutes.

A cystoscope (a long, thin tube) is placed through your urethra into the bladder. A guide wire is inserted through the cystoscope and into your ureter (tube between the bladder and kidney).

The cystoscope is then removed, leaving the guide wire in place. A ureteroscope (small camera to visualize the inside of the ureter and kidney) is passed over or beside the guide wire.

Once the suspect area is identified, a nylon or steel brush or biopsy forceps is placed through the ureteroscope and the lesion is rubbed with the brush, or a sample is collected with the biopsy forceps. When the brush or biopsy forceps is removed, the tissue from the lesion is removed from the instrument and the instrument and guide wire are completely removed from the body. The tissue is then sent to a pathology laboratory for analysis.

How to prepare for the test

Fasting for about 6 hours is generally recommended. Your health care provider will advise you regarding specific preparation.

You must sign a consent form. You will be given a mild sedative before the test.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel

Your bladder may feel full, and you may experience some cramping or discomfort during the test.

Afterward, you may have some mild cramping or discomfort. Some burning may occur the first few times you empty your bladder. There may also be some blood in your urine for a few days after the procedure.

Why the test is performed

This test is used to obtain a specimen of kidney (renal pelvis or calyx) or ureter tissue when X-ray (or other test) shows a lesion in this area or when there are suspicious cells in the urine.

Normal Values
The tissue appears normal.

What abnormal results mean

Abnormal results may indicate carcinoma cells - this test is often used to differentiate malignant (cancerous) and benign lesions

What the risks are

  • Allergy to iodine-based contrast agent used to help visualize the area - inform the health care provider if there you have allergies to seafood, as these may cause allergic reactions to the contrast agent.  
  • Allergy to anesthetic  
  • Bleeding  
  • Infection (urinary tract infection, pyelonephritis, or sepsis)  
  • Perforation (hole) of the ureter

Special considerations

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

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.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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