RENAL BIOPSY, CERVICAL BIOPSY
AND ENDOMETRIAL BIOPSY –
PROCEDURE, AFTER CARE OF PATIENT
RENAL BIOPSY
Renal tissue may be obtained for examination either by an open or a closed biopsy technique. An open biopsy requires the surgical procedure-involving an incision through the flank. However, the procedure is costly and has a prolonged recuperation period for the client.
One method of closed biopsy is the retrograde renal and urteral brush. The initial parts of a procedure are done as a cystoscopy. A ureteric catheter is passed and its position is confirmed by the fluoroscopy. A biopsy brush is then passed through the catheter and the lesion is brushed over several times. The brush is removed and any tissue adhering to the bristles is sent to the laboratory. If no tissue is found on the brush, 24 to 48 hour urine specimens may be collected to catch any cells that may have been dislodged by the bristles. Post-operatively, the client may have to be given intravenous fluids at a rapid rate to reduce the possibility of clot formation at the biopsy rate.
The most frequently used procedure is the percutaneous renal biopsy. The procedure is usually done under local anaesthesia. The client is placed in a prone position with a firm pillow under the abdomen. The client is instructed to take in as deep a breath as possible and hold it. The probe needle is inserted through the skin and positioned inside the renal capsule. After confirming its position, a biopsy is taken, when enough tissue has been obtained, the needle is removed and firm pressure is applied.
The contra-indications for percutaneous renal biopsy are:
Single functioning kidney, infection, malignant tumors, hydronephrosis, severe hypertension, coagulation disorders, previous history of renal failure, pregnancy and an uncooperative client. Before renal biopsy is done, thorough investigations are to be done such as I.V.P. urine culture, haematocrit, blood urea, bleeding time, clotting time etc. in the post operative period, the client should be kept on bed rest and encouraged to take plenty of fluids to prevent clot formation in the kidney. The care of client in the post biopsy period is same as in case of liver biopsy.
CERVICAL BIOPSY
Cervical biopsy is the removal of a small piece of tissue from the cervix for the histopathological examination. It can be done as a punch biopsy or cervical conization. In punch biopsy, one or more small pieces of tissues are removed from the cervix with a punch biopsy forceps. The cervical conization is done by taking a cone shaped section of the cervix with a scalpel or cervitome (cold knife conization) or by diathermy conization. These procedures are frequently performed on an outpatient basis. The biopsy is usually taken one week after the end of menstruation when the cervix is least vascular. The client usually experiences no pain during the cervical biopsy because the cervix does not contain nerve endings for pain.
The preparation of the client is as for a gynaecologic examination. The perineum is shaved and cleaned. The cervix is visualized in a good source of light and the biopsy is taken using a cervical biopsy forceps. The bleeding from the site is controlled by cauterization. An unpleasant odour results from the burning of tissues and the client may experience little discomfort. She may have a foul smelling discharge for few days. The client may be discharged on the same day with the following instructions:
a. To avoid any strenuous activity for the next 24 hours.
b. To report any bleeding immediately.
c. To abstain from sexual activities and douching until the doctor gives the permission.
d. To avoid using tampons until the doctor gives permission. Use clean pads.
The following articles are kept ready for cervical biopsy:
A covered sterile tray containing:
1. Sponge holding forceps, for cleaning.
2. Valsellum forceps to hold the cervix.
3. Biopsy forceps
4. Vaginal speculum (sim’s)
5. Small bowls to take cleaning lotion.
6. Gloves, gowns and masks.
7. Leggings and dressing towels
8. Specimen bottles
9. Cotton balls, gauze pieces, and cotton pads
An unsterile tray containing:
1. Mackintosh and towel
2. Kidney tray and paper bag
3. Cleaning lotion
4. Apron for the doctor
5. Formalin 10 percent
6. Cautery with its tip sterilized
7. Good source of light
ENDOMETRIAL BIOPSY
Endometrial biopsy is done by scraping the lining of the uterine cavity with a curette. It can be done as an outpatient procedure using a Novak curette. This curette is devised for the sampling of the endometrial tissues and for an evaluation of the endometrial cavity. The diameter of the curette is approximately 5 mm and it can be passed through the smallest cervical canal even in those women who have not undergone childbearing.
Another method is by dilatation of the cervix and curettage of an endometrium, commonly known as ‘dilatation and curettage’ or ‘D and C’. The dilatation and curettage of an endometrium is done either with a diagnostic or a therapeutic purpose. It is done in the operation under general anaesthesia. The purpose of D and C is:
1. To control dysfunctional uterine bleeding
2. To complete an incomplete abortion
3. As a method used for the medical termination of pregnancy before 13th week of gestation.
4. To relieve dysmenorrhoea by the cervical dilatation
5. To remove polyps of an endometrium
6. To diagnose uterine malignancy
7. To diagnose the cause of sterility. A curettage done premenstrually will give definite information on the luteal phase of the current cycle.
8. To diagnose the cause of bleeding from a cervical stump
9. To rule out extension of cervical carcinoma into an endometrium. It is frequently performed in conjunction with cervical conization.
10. To explore the uterine cavity for irregularities that may be caused by a submucus fibroid which was undetected through bimanual palpation.
Preparation of Articles
A covered sterile tray containing:
1. Hegar’s dilators 1 set
2. Valsellum forceps
3. Ovum forceps (if D and C is done to evacuate uterus after abortion)
4. Uterine sound
5. Curette sharp and blunt
6. Vaginal speculum (sim’s)
7. Metal catheter (female)
8. Sponge holding forceps
9. Small bowl
10. Dressing towels and leggings.
11. Gloves, gowns and masks
12. Specimen bottles
13. Cotton balls, gauze pieces, cotton pads
An unsterile tray containing:
1. Mackintosh and towel
2. Kidney tray and paper bag
3. Cleaning lotions
4. Apron for the doctor
5. Formalin 10 percent
6. Good source of light
Preparation of the Client
Explain the procedure to the client to win her confidence and co-operation
Shave and clean the perineum
Make the client on fast for 6 to 8 hours prior to the procedure
Give an enema to empty the lower bowels
Change the client’s garments into the hospital clothes
Get the consent of the client for general anaesthesia
Give the premedication before sending the client to the operation room
Empty the bladder before sending the client to the operation room
PROCEDURE
The client is placed in a lithotomy position with the legs supported on the stirrup rods. A general anaesthesia is given. After cleaning the perineum and catherization of the bladder, the vaginal speculum is introduced into the vagina and the cervix is viewed. The cervix is held by the valsellum forceps. The length and direction of the uterine cavity is assessed by a uterine sound to avoid perforation of the uterus. The Hegar’s dilators are passed through the cervix into the uterus in order to widen the cervix. The endometrium is scraped with the curette.
After Care of the Client
1. If the client had general anaesthesia, the care of the client is as for an unconscious client
2. Watch the pulse and blood pressure of the client every 10 to 20 minutes for few hours.
3. Watch for bleeding. The perineal pad should be inspected to detect bleeding per vagina.
4. Watch for voiding. Client may experience retention of urine due to the interference with the genitor-urinary system.
5. The client may complain of pain; a dilated cervical canal stimulates uterine contractions. Mild analgesics may relieve pain.
6. If the client complains of severe pain and if there is raising pulse rate it should be reported to the doctor. It may be due to the perforation of the uterus.
7. Send the specimen to the lab with proper labels and requisition form.
8. The client may be discharged on the next day with the following instructions:
a. Avoid strenuous activity for a week. Do not lift weights.
b. Avoid douching and sexual activity until the doctor permits.
c. Expect a vaginal discharge during the healing phase after the procedure. Use clean pads and avoid tampons.
d. The subsequent menstrual period may or may not be affected.
