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Biopsy of the Kidneys, Bladder, and Prostate

By Bradley D. Figler, MD, Assistant Professor of Urology, University of North Carolina

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Biopsy requires a trained specialist (nephrologist, urologist, or interventional radiologist).

Renal biopsy

Indications for diagnostic biopsy include unexplained nephritic or nephrotic syndrome or acute kidney injury. Biopsy is occasionally done to assess response to treatment. Relative contraindications include bleeding diathesis and uncontrolled hypertension. Mild preoperative sedation with a benzodiazepine may be needed. Complications are rare but may include renal bleeding requiring transfusion or radiologic or surgical intervention.

Bladder biopsy

Bladder biopsy is indicated to diagnose certain disorders (eg, bladder cancer, sometimes interstitial cystitis or schistosomiasis) and occasionally to assess response to treatment. Contraindications include bleeding diathesis and acute tuberculous cystitis. Preoperative antibiotics are necessary only if active UTI is present. The biopsy instrument is inserted into the bladder through a cystoscope; rigid or flexible instruments can be used. The biopsy site is cauterized to prevent bleeding. A drainage catheter is left in place to facilitate healing and drainage of clots. Complications include excessive bleeding, UTI, and bladder perforation.

Prostate biopsy

Prostate biopsy is usually done to diagnose prostate cancer. Contraindications include bleeding diathesis, acute prostatitis, and UTIs. Patient preparation includes stopping aspirin, antiplatelet drugs, and anticoagulants one week before biopsy; preoperative antibiotics (usually a fluoroquinolone); and an enema to clear the rectum. With the patient in a lateral position, the prostate is located by palpation or, preferably, transrectal ultrasonography. Overlying structures (perineum or rectum) are anesthetized, a spring-loaded biopsy needle is inserted into the prostate, and usually 12 tissue cores are obtained. Complications include the following:

  • Urosepsis

  • Hemorrhage (including hematuria and rectal bleeding)

  • Urinary retention

  • Hematuria

  • Hematospermia (often for 3 to 6 mo after biopsy)

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