Ask the experts

 Why Would Someone Need a Renal Mass Biopsy?

Kidney and renal pelvis cancers are among the leading causes of cancer death in the United States. Kidney cancer is ninth on the list of the 10 most common types of cancer. Almost all of the kidney cancers in the United States are renal cell carcinomas (RCC). These cancers form in the lining of the small tubes in the kidney.

There are no routine lab tests to find kidney cancer. Often tumors are found during genetic screening, or when they are seen on imaging (like ultrasound or CT scan) when you see a doctor about another problem. 

In many cases, the urologist can tell by appearance on a scan whether a mass in the kidney is a cancer or not, but sometimes that is not the case. If so, a renal mass biopsy may be done to find out if the mass is a cancer. A biopsy is when cells or tiny parts of an organ are removed and studied. For renal mass biopsy, your doctor uses imaging to guide a small needle through the skin into the mass. A pathologist views the sample under a microscope. A pathologist is a doctor who can check for signs of cancer.

The biopsy will show if the mass started in another part of your body or if it started in the kidney. A biopsy may also tell if there is an infection, such as an abscess. It can help find cancer and help you make better treatment choices.

Dr. J. Stuart Wolf is associate chair of clinical integration and operations and professor for the Department of Surgery and Perioperative Care at Dell Medical School at the University of Texas in Austin. 

 What is a Urethral Diverticulum? 

Urethral diverticulum (UD) is a pocket or pouch that forms along the urethra. Because of its location, it can be filled with urine and lead to infections. It is can cause:

  • A painful vaginal mass
  • Ongoing pelvic pain
  • Many urinary tract infections (UTI)

It is rare, but more common in women between age 40-70. Children are not usually affected, unless they’ve had urethral surgery.

With better imaging, more cases of UD have been found and treated. Still, many cases are missed or misdiagnosed. 

The cause of a UD is not clear. It is often linked to repeat infections causing weakness in the urethra wall. A block in the glands near the urethra may also cause it. Earlier studies have also pointed to a birth defect or trauma during childbirth as a UD cause.

Surgical excision is often the treatment of choice for UD. If you prefer not to have surgery, counseling and follow-up visits with your doctor are important to prevent problems. 

Aaron Spitz, MD is a urologist in Orange County, California. He is also the author of The Penis Book: A Doctor’s Complete Guide to the Penis From Size to Function and Everything in Between. 

 What is Bluelight Cystoscopy?

Bladder cancer is the fifth most common non-skin cancer in the United States, with nearly 81,000 people expected to be diagnosed in 2019. 

Bladder cancer comes from the tissues that line the inner surface of the bladder. Painless blood in the urine is the most common symptom of bladder cancer. The diagnosis is suspected when the doctor sees a tumor during an office procedure called a cystoscopy. Bladder cancer is confirmed during an outpatient surgery called transurethral resection of a bladder tumor (TURBT). The combination of an imaging study (such as CT scan) and the results from TURBT can find out the stage of your cancer.

TURBT is a very important procedure for accurate tumor typing, staging and grading. Your doctor can look inside the bladder, take tumor samples and cut away what they see of your tumor.

Blue light cystoscopy is one way to enhance traditional TURBT. Before blue light cystoscopy, a catheter is inserted through the urethra into the bladder, and an imaging solution called Cysview is left in the bladder for about an hour. It works because bladder cancer cells multiply more rapidly than the surrounding normal bladder lining. Cysview is preferentially absorbed by these more rapidly dividing cancer cells. Under blue light during TURBT, the cancer cells glow fluorescent pink, which makes it easier to see the edges of the bladder tumor and to ensure a more complete resection. 

TURBT with blue light cystoscopy has been shown to reduce tumors from coming back by 12-43 percent (depending on the type of tumor you have).

Dr. Benjamin Ristau is a urologist with UConn Health in Farmington, Connecticut,  |  SPRING 2019  |  UROLOGYHEALTH extra