Technical Notes and Tips: The Use of Cough to Sample Detrusor Muscle During Flexible Cystoscopic Biopsy

Abstract

During flexible cystoscopy, a biopsy may be required. Whilst it is useful to sample detrusor, controlling biopsy depth is frustrating and samples will frequently not yield muscle. We describe a simple technique that will ensure detrusor muscle sampling. During cystoscopy, the biopsy area is located and flexible forceps are introduced into the bladder. With the forceps open, push against the target region such that the bladder wall is slightly indented. The patient is asked to cough and, whilst simultaneously maintaining constant pressure against the wall, close the forceps. With the instrument's mouth closed, again ask the patient to cough and swiftly withdraw the forceps. This successful method is very easy to use and conjures no additional cost. Furthermore, we have observed that patients' subjective perception of pain is lowered.