FLEXIBLE CYSTOSCOPIC BLADDER BIOPSIES - A TECHNIQUE FOR OUTPATIENT EVALUATION OF THE LOWER URINARY-TRACT UROTHELIUM

Routine urothelial biopsies of the lower urinary tract are obtained us ing the cold cup biopsy technique. This procedure is most often perfor med in the surgical suite and requires rigid endoscopic access and the use of biopsy forceps and Bugbee electrodes to obtain tissue for hist ologic examination. A new single-step biopsy forceps has been used thr ough the flexible cystoscope. Using a 16 F actively deflectable, flexi ble cystoscope and the 5.4 F Therma Jaw Hot Urologic Forceps, bladder biopsies were obtained in 27 patients for a variety of indications. Th is biopsy forceps allows simultaneous tissue sampling and electrocoagu lation of the biopsy site, thus eliminating the need for exchange of i nstruments through the flexible cystoscope. Tissue samples are somewha t protected from thermal changes during coagulation through the use of a Faraday cage. Biopsies were frequently obtained in an outpatient se tting, requiring only local topical anesthesia (2% lidocaine jelly). C arcinoma in situ, transitional cell carcinoma, acute and chronic infla mmation, and normal bladder mucosa were differentiated histologically. Using this technique, lower urinary tract urothelial mapping can be p erformed safely in the office with minimal patient discomfort.