Biopsy of the urinary tract requires a trained specialist (nephrologist, urologist, or interventional radiologist).
Indications for diagnostic biopsy include unexplained nephritic Overview of Nephritic Syndrome Nephritic syndrome is defined by hematuria, variable degrees of proteinuria, usually dysmorphic red blood cells (RBCs), and often RBC casts on microscopic examination of urinary sediment. Often... read more or nephrotic syndrome Overview of Nephrotic Syndrome Nephrotic syndrome is urinary excretion of > 3 g of protein/day due to a glomerular disorder plus edema and hypoalbuminemia. It is more common among children and has both primary and secondary... read more or acute kidney injury Acute Kidney Injury (AKI) Acute kidney injury is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood (azotemia) with or without reduction in amount of urine... read more or concern for renal malignancy. Biopsy is occasionally done to assess response to treatment. Relative contraindications include bleeding diathesis and uncontrolled hypertension Hypertension Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both. Hypertension with no known cause (primary; formerly, essential... read more . 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 is indicated to diagnose certain disorders (eg, bladder cancer, sometimes interstitial cystitis Interstitial Cystitis Interstitial cystitis is noninfectious bladder inflammation that causes pain (suprapubic, pelvic, and abdominal), urinary frequency, and urgency with incontinence. Diagnosis is by history and... read more or schistosomiasis Schistosomiasis Schistosomiasis is infection with blood flukes of the genus Schistosoma, which are acquired transcutaneously by swimming or wading in contaminated freshwater. The organisms infect the... read more ) and occasionally to assess response to treatment. Contraindications include bleeding diathesis and acute tuberculous cystitis. Preoperative antibiotics are necessary only if active urinary tract infection (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. Based on the extent of the biopsy, a drainage catheter may be left in place to facilitate healing and drainage of clots. Complications include excessive bleeding, urinary retention Urinary Retention Urinary retention is incomplete emptying of the bladder or cessation of urination. Urinary retention may be Acute Chronic Causes include impaired bladder contractility, bladder outlet obstruction... read more , UTI, and bladder perforation.
Prostate biopsy is usually done to diagnose prostate cancer Prostate Cancer Prostate cancer is usually adenocarcinoma. Symptoms are typically absent until tumor growth causes hematuria and/or obstruction with pain. Diagnosis is suggested by digital rectal examination... read more . Contraindications include bleeding diathesis, acute prostatitis Prostatitis Prostatitis refers to a disparate group of prostate disorders that manifests with a combination of predominantly irritative or obstructive urinary symptoms and perineal pain. Some cases result... read more , and UTIs Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more . Patient preparation includes stopping aspirin, antiplatelet drugs, and anticoagulants appropriately before biopsy; preoperative antibiotics (usually a fluoroquinolone); and an enema to clear the rectum. With the patient in a lateral or lithotomy position, the prostate is located by palpation or, preferably, transrectal ultrasonography in which an ultrasound probe inserted in the rectum provides images to help guide placement of the biopsy needle. The needle typically is inserted through the ultrasonography probe or may, alternatively, be inserted through the perineum. Multiple samples (10 to 20) are usually taken. When available, an MRI image can be digitally combined (fused) with the ultrasonographic image to better identify lesions that need to be biopsied. MRI fusion biopsy is based on the MRI PI-RADS system in which the malignant potential of a multiparametric MRI is expressed on a scale of 1 (low risk) to 5 (highest risk) of identifying an aggressive cancer.
Overlying structures (perineum or rectum) are anesthetized, a spring-loaded biopsy needle is inserted into the prostate, and tissue cores are obtained. Complications include the following:
Hemorrhage (including hematuria and rectal bleeding)
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