Instruments for Upper Tract Biopsy and Treatment

Abstract

From the introduction of endoscopic approaches to genitourinary disease at the beginning of the nineteenth century to advances in 1970s that ushered in the current era of Endourology, the field has undergone continuous growth based on improved visualization, advances in scope design and instrument innovation. Currently available techniques offer access to the entire urinary tract via a retrograde ureteral or antegrade percutaneous approach for the inspection, biopsy, and treatment of the spectrum of benign and malignant pathology. While urine studies and cross-sectional imaging are utilized in the initial evaluation, direct visual inspection, and biopsy is required for the assessment of any abnormal findings. The current generation of digital flexible ureteroscopes are lighter and less cumbersome than their predecessors with better image quality. Instruments including forceps, baskets, and resection loops are available to maximize the diagnostic yield of endoscopic biopsy. Despite progress, it is critical to recognize that undergrading and understaging remain a significant concern even for experienced practitioners. This can best be tempered with a comprehensive evaluation of the entire urothelium, systematic approach to specimen collection and close clinical follow-up. In this chapter, we review basic endoscopic techniques for the biopsy of upper urinary tract lesions.