[Retrograde brush biopsy of the kidney pelvis and ureters]

Brush biopsies of the kidney and ureter have become established as the most definitive method for the determination of the etiology of lesions arising in or invading into the urinary collecting passages. Retrograde brushing via cystoscopic passage of open-end brushing catheters (5 to 8 French) with subsequent brushing of lesions under TV monitored image intensified fluoroscopic control is the most widely employed brushing technique. Antegrade brush biopsies via percutaneous passage of catheters through the renal pelvis has recently been described by Lang. Recent additions to retrograde brush biopsy include steerable or manipulable tips of brushing catheters to facilitate access to minor calyces. Ureteroscopy with rigid transcystoscopic ureteroscopes has been developed by Lyon to facilitate passage of brushing catheters and in selected instances the direct endoscopic observation of lesion during brushing. Both brushing histology and brushing cytology, with smears of brushes and saline washes post brushing, are integral parts of brush biopsies. Urothelial cytopathology requires special expertise in interpretation of the various effects of drugs, iodine radiographic media and inflammatory lesions on the various cell types of the urothelial layers. The safety and efficacy of retrograde brush biopsy has been published by Gittes (J Urol (1981) 126:146) from his survey of 70 urologists.