Ureteral retrograde brush biopsy is a procedure that takes a small sample of tissue from the lining of the kidney or ureter (tube that connects a kidney to the bladder). The tissue is sent to a lab for testing.
This procedure is done using regional (spinal) or general anesthesia so you will not feel any pain. The test takes about 30 - 60 minutes.
A tube with a camera on the end (cystoscope) is first placed through the urethra into the bladder. Then a guide wire is inserted through the cystoscope into the ureter (the tube between the bladder and kidney).
The cystoscope is removed, leaving the guide wire in place. A longer, thinner telescope (ureteroscope) with a small camera is then inserted over or next to the guide wire to see the inside of the ureter or kidney.
A nylon or steel brush is placed through the ureteroscope. The area to be biopsied is rubbed with the brush. Biopsy forceps may be used instead to collect a tissue sample.
The brush or biopsy forceps is removed. The tissue is taken from the instrument and sent to a pathology laboratory for analysis. The instrument and guide wire are removed from the body. A small tube or stent may be left in the ureter to prevent a kidney blockage caused by swelling from the procedure. It is removed later.
How to Prepare for the Test
You may not be able to eat or drink anything for about 6 hours before the test. Your health care provider will tell you how you need to prepare.
How the Test will Feel
You may have some mild cramping or discomfort after the test is over. You may have a burning feeling the first few times you empty your bladder. You may also urinate more often or have some blood in your urine for a few days after the procedure.
Why the Test is Performed
This test is used to take a sample of tissue from the kidney (renal pelvis or calyx) or ureter. It is performed when an x-ray or other test has shown a suspicious area (lesion), or there are abnormal cells in the urine.
The tissue appears normal.
What Abnormal Results Mean
Abnormal results may show cancerous cells (carcinoma). This test is often used to tell the difference between cancerous (malignant) and noncancerous (benign) lesions.
A small amount of blood in the urine is normal the first few times you urinate after the procedure. Your urine may look faintly pink. Report very bloody urine or bleeding that lasts longer than three emptyings of the bladder to your health care provider.
Call your health care provider if you have:
Pain that is bad or is not getting better
Very bloody urine
Bleeding that continues after you have emptied your bladder three times
Sagalowsky AI, Jarrett TW, Flanigan RC. Urothelial tumors of the upper urinary tract and ureter. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 53.
Scott Miller, MD, Urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.