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Biopsy of the Kidneys, Bladder, and Prostate

By

Paul H. Chung

, MD, Sidney Kimmel Medical College, Thomas Jefferson University

Last full review/revision May 2020| Content last modified May 2020
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Biopsy of the urinary tract requires a trained specialist (nephrologist, urologist, or interventional radiologist).

Renal biopsy

Bladder biopsy

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 vasculature... 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. 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 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 1 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 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 12) 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.

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:

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