Name of the Procedure:

Endoluminal Biopsy of Ureter and/or Renal Pelvis, Non-Endoscopic, including Imaging Guidance (e.g., Ultrasound and/or Fluoroscopy) and all Associated Radiological Supervision and Interpretation.

Summary

An endoluminal biopsy of the ureter and/or renal pelvis is a minimally invasive procedure where tissue samples are taken from the ureter or renal pelvis using imaging guidance, such as ultrasound or fluoroscopy, without the use of an endoscope. The collected tissue is then analyzed to diagnose or monitor conditions affecting these areas.

Purpose

The main purpose of the endoluminal biopsy of the ureter and/or renal pelvis is to diagnose and monitor conditions like infections, cancers, or other abnormalities in the urinary tract. The procedure aims to obtain accurate tissue samples while minimizing patient discomfort and risk.

Indications

This procedure is indicated for patients with:

• Unexplained hematuria (blood in the urine).
• Suspicious masses or lesions detected via imaging.
• Persistent or recurrent urinary tract infections.
• Unexplained flank or abdominal pain related to the urinary system.
• Monitoring of known pathologies for progression or response to treatment.

Preparation

• The patient may need to fast for several hours before the procedure.
• Pre-procedure imaging tests, such as a CT scan or MRI, may be required.
• Medications, especially blood thinners, might need to be adjusted.
• The patient should arrange for someone to drive them home after the procedure.

Procedure Description

1. The patient is positioned on the examination table.
2. Local anesthesia is administered to numb the area.
3. Using imaging guidance (like ultrasound or fluoroscopy), the physician identifies the target area in the ureter or renal pelvis.
4. A needle or catheter is carefully inserted through the skin and guided to the target area.
5. Tissue samples are taken using specialized biopsy tools.
6. The site is monitored for any complications, and the needle or catheter is removed.
7. The samples are sent to a lab for pathological analysis.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital radiology department, outpatient clinic, or a surgical center.

Personnel

• Radiologist or an interventional urologist.
• Radiologic technologist.
• Nursing staff.
• Anesthesiologist or nurse anesthetist (if sedation is used).

Risks and Complications

Common risks include:

• Bleeding at the biopsy site.
• Infection.
• Pain or discomfort. Rare complications may include:
• Damage to the ureter or surrounding organs.
• Hematoma formation.

Benefits

The benefits of this procedure include:

• Accurate diagnosis of urinary tract conditions.
• Minimally invasive with a relatively quick recovery time.
• Early detection and monitoring of cancers or other abnormalities.

Recovery

• Patients may experience mild pain or discomfort at the biopsy site.
• Over-the-counter pain relief medications may be recommended.
• Patients should avoid strenuous activities for a few days.
• Follow-up appointments will be scheduled to discuss biopsy results and any further treatment.

Alternatives

• Cystoscopic biopsy (endoscopic approach).
• Imaging-based diagnostics (CT, MRI, ultrasound without biopsy).
• Non-invasive urine tests. Each alternative has its own set of pros and cons, such as less invasiveness versus potentially lower diagnostic accuracy.

Patient Experience

During the procedure, patients may feel pressure or slight discomfort but severe pain is rare due to local anesthesia. After the procedure, mild soreness can occur at the entry site but is typically manageable with pain relief medications. It is essential to follow post-procedure instructions to ensure quick recovery and minimize complications.