RU2641838C1 - Method for suprapubic multifocal depth-regulated bladder biopsy under endoscopic control - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: cystoscope is inserted before the biopsy material is taken from the bladder. The bladder is filled with an antiseptic solution. Using a suprapubic extraperitoneal access the anterior abdominal wall and the bladder wall are pierced layer wise by a hollow needle with a plug. Under visual control, the end of the needle is brought to the neoplasm. Biopsy is performed by the needle of an automatic biopsy gun through the hollow needle tube.

EFFECT: method allows to accurately obtain biopsies of all layers of bladder wall neoplasm under cystoscopic control.

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Description

This method relates to medicine, in particular to urology.

A known endoscopic method for taking a biopsy of a bladder neoplasm with special biopsy forceps (Urology Guide: 3 T. T. 1. Edited by Acad. R 84 RAMS N.A. Lopatkina. - M .: Medicine, 1998. - 304 s) . Under visual control, a special urological instrument, a cystoscope, is inserted into the bladder. Through the cystoscope, the bladder is filled with an antiseptic solution for the full visualization of all its walls. A flexible instrument, biopsy forceps, is carried out along the working channel of the cystoscope. Using biopsy forceps, under visual control, fragments of neoplasms or a pathologically altered mucosa of the bladder are plucked. Biopsy forceps are removed from the cystoscope, the material is sent for histological examination.

The disadvantages of this method are: 1) surface sampling using biopsy forceps of biopsy material from the neoplasm or pathologically altered bladder mucosa; 2) the complexity of interpreting the spread of the pathological process to the deeper layers (muscle, serous) of the bladder using the obtained biopsy material.

Close to claimed is transurethral resection (TUR) - a biopsy of bladder neoplasms (Clinical recommendations of the European Association of Urology. Recommendations for invasive and metastatic bladder cancer: JA Witjes (Chair), E. Comperat, NC Cowan, et al. Volume 1. 2014 . - 21 p.). With this method, a special instrument, a resectoscope, is introduced into the bladder under spinal anesthesia or anesthesia. Under endoscopic control, electrical resection of the neoplasm or pathologically altered bladder mucosa occurs up to its muscle layer.

The main disadvantages of the prototype are: 1) the need for spinal anesthesia or anesthesia; 2) the absence of all layers of the wall of the bladder in the biopsy material, which impairs the accuracy of histological diagnosis; 3) the possibility of histological differentiation of biopsy material obtained during electrical resection is reduced; 4) the difficulty of capture and extraction of the resected biopsy material from the bladder.

The objective of the invention is to take a complete biopsy material for histological examination of the neoplasm and all layers of the bladder wall.

According to the invention, the task is achieved by the fact that a cystoscope is inserted into the bladder. Through the cystoscope, the bladder is filled with an antiseptic solution. In the suprapubic area, extraperitoneally, under local anesthesia, a cannula with a rubber plug at the proximal end punctures the anterior abdominal wall and the anterior wall of the bladder. Under the visual control of the cystoscope, the distal end of the needle is brought to a neoplasm or to a pathologically altered bladder mucosa. Through the needle tube, a biopsy gun needle is inserted into the bladder cavity. Under endoscopic control, the biopsy needle is pulled out from the tube of the hollow needle and injected into the neoplasm of the bladder or pathologically altered mucosa, where a biopsy from all layers of the neoplasm and bladder is collected using an automatic shot of a biopsy gun with a predetermined depth of penetration into the tissue. The biopsy needle is removed from the cannula tube and freed from the biopsy. The procedure for sampling biopsy material in this way can be carried out several times from different sites of the neoplasm or pathologically altered bladder mucosa. At the end of the procedure, a hollow needle is removed from the bladder cavity, and then a cystoscope.

This method allows you to get complete biopsy samples of all layers of the neoplasm and pathologically altered bladder mucosa, which gives a reliable histological conclusion that affects the optimal treatment tactics of the patient.

According to the scientific, technical and patent literature, the method of suprapubic multifocal sampling of a biopsy from the bladder under endoscopic control is not known.

The method of suprapubic multifocal sampling of a biopsy from the bladder is shown in the drawings (Fig. 1, 2, 3, 4).

FIG. 1. The cystoscope - 1 is introduced into the cavity of the bladder - 2. After filling the bladder with an antiseptic raster, the formation of the bladder is detected - 3.

FIG. 2. In the suprapubic region - 4 with a hollow needle - 5 with a rubber plug at the proximal end - 6, the anterior abdominal wall and the anterior wall of the bladder are punctured layer-by-layer. 7. Under visual cystoscope control - 1 distal end of the hollow needle in the bladder cavity - 2 is connected to bladder formation - 3.

FIG. 3. Through the proximal end of the needle with a rubber plug - 6, a biopsy needle with a gun - 8 is inserted into the needle - 5.

FIG. 4. A biopsy needle with a gun - 8 in the cavity of the bladder - 2 leads to the formation of the bladder - 3. The sharp end of the biopsy needle - 9 is pulled out of the tube.

FIG. 5. Under the visual control of the cystoscope - 1, a biopsy needle with a gun - 8 is automatically shot, as a result of which the sharp end of the needle - 9 punctures the entire wall of the formation of the bladder - 3.

Clinical example: In patient E., cystoscopy on the right wall of the bladder revealed a papillary mass 1.5 × 2.0 cm in size. Through the suprapubic area, puncture the front wall of the bladder with a hollow needle. A biopsy needle was inserted through the cannula into the bladder cavity and, under the endoscopic cystoscope control, a multifocal deep biopsy was taken from the papillary mass through all layers of the bladder (3 columns). After removal of the hollow -i needle from the bladder cavity through which the biopsy was performed, a cystoscope was removed.

Claims (1)

A method of suprapubic multifocal biopsy of a bladder under cystoscopic control, characterized in that a cystoscope is inserted into the bladder through which a bladder is filled with an antiseptic solution, in the suprapubic region extraperitoneally under local anesthesia, a hollow needle with a rubber plug at the proximal end punctures the anterior abdominal wall the wall of the bladder, under the visual control of the cystoscope, the end of the needle is led to a neoplasm or to a pathologically altered bladder mucosa, b opsiyu operate automatic needle biopsy gun barrel through the cannula, after the procedure of the cavity of the bladder cannula was removed and the cystoscope.

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