Biopsy Specimens

Rigid or flexible cystoscopy allows direct visualisation of macroscopic bladder pathology for evaluation and biopsy of small lesions using either "cold" cup forceps or a small diathermy loop. The latter may cause significant heat artefact, reducing the value of histologic assessment. Rigid cystoscopy employs a larger lumen allowing superior visualisation (better optics and water flow), greater versatility in the passage of accessory instruments and easier manipulation. It also provides suitable access for transurethral resection of superficial bladder tumours with diathermy (TURB). Flexible cystoscopy is more comfortable for the patient, may be easier to pass and allows a range of angles of visualisation within the bladder. Cystoscopy should be avoided during active urinary tract infection as instrumentation can exacerbate the condition. Carcinoma in situ may be invisible to the endoscopist and necessitate random biopsies to make the diagnosis. Distinction from interstitial cystitis may require multiple biopsies as the surface can be extensively denuded. In the presence of an overt tumour it is important to sample abnormal mucosa (red, velvety) distant from the lesion to look for in situ malignancy. Sampling normal-looking mucosa adjacent to tumour is not advised due to the potential risk of tumour re-implantation. Deep biopsies (including muscularis propria) are essential to provide important staging information in invasive tumours.

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