How Ureteroscopy With Biopsy Confirms a Ureteral Tumor and Sets the Treatment Plan

The phone call usually comes a few days after the scan. Someone went in for blood in the urine that would not explain itself, and now a radiologist has written the words ‘filling defect in the left ureter’ on a report. The urologist is calm about it, but the next sentence is the one that lands: we need to look inside and take a sample. That is where ureteroscopy biopsy for a suspected ureteral tumor enters the story, and where most people realize they have never heard of it.

It is a strange position to be in. A shadow on a CT scan is not a diagnosis, yet it is already rearranging your week. You want to know whether it is cancer, whether the kidney is at risk, and whether the test itself is going to hurt.

This explainer walks through what actually happens, what the tiny piece of tissue can and cannot tell a pathologist, and how that result becomes a treatment plan. The honest parts are included on purpose, because they are the parts patients say nobody explained.

What happens during ureteroscopy with biopsy for a suspected ureteral tumor

The ureter is the narrow muscular tube, roughly the width of a drinking straw, that carries urine from each kidney down to the bladder. Ureteroscopy is a procedure in which a urologist passes a thin telescope through the urethra and bladder and up into that tube, so the lining can be seen directly rather than inferred from a scan. Add a biopsy, which simply means removing a small piece of tissue to examine under a microscope, and you have the test that most often turns ‘there is something in the ureter’ into a named diagnosis.

Two kinds of instruments share the work. A semi-rigid ureteroscope handles the lower, straighter part of the ureter. A flexible scope, thinner than a pencil lead and steerable at the tip, negotiates the bends higher up and can enter the renal pelvis, the funnel where the kidney collects urine before it drains. Both carry a working channel through which tiny wire baskets, cup-shaped forceps or a laser fiber can pass.

Once the surgeon reaches the abnormal area, several things happen in sequence. The lesion is photographed, and its position, size, shape and number are recorded. Urine is often collected from directly above it for cytology, the study of loose cells shed into fluid. Then tissue is sampled, usually more than once, because each fragment is only a few millimeters across and the pathologist needs enough to judge how abnormal the cells look. Cleveland Clinic describes the procedure as typically lasting under an hour, with most people going home the same day.

The goal is broader than a yes or no. The biopsy grade, combined with what the surgeon saw, is what urology guidelines use to sort patients into lower-risk and higher-risk groups, and that sorting shapes every decision that follows.

Why a CT scan and a urine test usually cannot settle the question alone

Most ureteral tumors are first suspected on a CT urogram, a CT scan timed so that contrast dye fills the urinary tract and outlines its inner surface. Anything that blocks the dye shows up as a ‘filling defect.’ The trouble is that several very different things produce the same shadow: a blood clot, a stone that does not contain calcium, a benign fibrous polyp, a fold of inflamed lining, even a piece of kidney tissue that has sloughed off. A scan sees shape. It does not see cell type.

Urine cytology helps, but unevenly. High-grade tumor cells look so abnormal that they are often recognizable even when they are floating loose in urine. Low-grade cells, by contrast, resemble normal lining cells closely enough that cytology frequently misses them. A negative cytology report therefore lowers concern without removing it, and a positive report still does not say where in the urinary tract the cells came from.

Hydronephrosis, the swelling of a kidney when urine backs up behind a blockage, is a further clue the radiologist will mention. It suggests the lesion is obstructing, and in guideline risk models it counts toward the higher-risk side, but it is not proof of invasion on its own.

Because the same lining, called the urothelium, runs continuously from the kidney’s collecting system through the ureter and across the whole bladder, the urologist will almost always inspect the bladder with a cystoscope at the same sitting. Cystoscopy is a look inside the bladder with a telescope passed through the urethra. Finding a bladder tumor as well would change the plan, so both territories are checked before anyone talks about treatment.

Put simply, imaging raises the question and cytology sharpens it. Direct vision plus tissue is what usually answers it.

Is urothelial cancer a rare cancer, and why does that matter here?

Urothelial carcinoma is the name for cancer arising from the urothelium, the specialized lining shared by the renal pelvis, the ureters and the bladder. In the bladder it is common. In the upper tract, meaning the ureter and renal pelvis, it is uncommon; the National Cancer Institute describes transitional cell cancer of the renal pelvis and ureter as a rare disease compared with bladder cancer, and the two upper-tract sites together account for only a small share of all urothelial tumors. Mayo Clinic notes that ureteral cancer occurs most often in older adults and in people with a history of bladder cancer.

Rarity has practical consequences that patients rarely hear spelled out. The first is that the research base is thinner. Many treatment recommendations for upper-tract disease are extrapolated from the far larger bladder cancer literature, and guideline authors say so openly. When a clinician answers a question with ‘we think’ rather than ‘we know,’ that is usually honesty rather than evasion.

The second is that risk factors matter for the whole family, not only the patient. Tobacco smoking is the best-established risk factor. Certain occupational exposures to industrial dyes and chemicals, and a plant toxin called aristolochic acid found in some traditional remedies, are also linked. Lynch syndrome, an inherited condition caused by faults in DNA-repair genes, raises the risk of upper-tract urothelial cancer as well as bowel and womb cancers, which is why some patients, especially younger ones or those with a strong family history, are offered genetic counseling.

The third consequence is surveillance. Because the urothelium behaves as one connected field, a tumor in the ureter means the bladder needs checking over time, and a bladder tumor means the upper tract does. Ureteroscopy is often part of both stories.

What the pathologist is looking for: grade, and why a small sample carries so much weight

Two words dominate every cancer conversation, and they are not interchangeable. Grade describes how abnormal the cells look under the microscope: low-grade cells still resemble normal lining and tend to grow slowly, while high-grade cells look disorganized and behave more aggressively. Stage describes how far the tumor has grown, from the surface lining into the muscle of the ureter wall and, potentially, beyond it.

A ureteral biopsy is good at grade and poor at stage. The reason is anatomical. The ureter wall is only a couple of millimeters thick, so the surgeon deliberately samples the surface rather than digging down, because taking a deep bite risks punching a hole through the tube. The pathologist therefore sees the tumor’s cells but usually not its roots. Guidelines acknowledge this and treat grade, not biopsy stage, as the biopsy’s main contribution.

Even grade can be underestimated. Fragments are small and can be crushed or distorted in the forceps, and a tumor may contain a mixture of low-grade and high-grade areas with the sample landing in the tamer part. This is why surgeons record what they saw alongside the grade: a papillary tumor, meaning one that grows in delicate finger-like fronds, tends to be lower risk, whereas a sessile tumor, flat and broad-based, worries them more. Cytology from above the lesion adds a third, independent opinion.

The report you eventually read may also mention ‘lamina propria’ or ‘muscularis,’ the layers beneath the lining. If those layers are present in the sample and clear, that is reassuring; if they are absent, the pathologist simply cannot comment on depth. Neither is a failure of the biopsy. It is the limit of what a surface sample can show, and your team will weigh it in that light.

Who is usually offered ureteroscopy biopsy for a ureteral tumor, and who is asked to wait

The clearest candidates are people whose CT urogram shows a filling defect or a thickened ureter wall, and people with persistent blood in the urine whose bladder looks normal on cystoscopy. A positive urine cytology with a clean bladder points upward for the same reason. Those under surveillance after bladder cancer are another large group, because their upper tract needs checking whenever imaging or cytology raises a flag.

Ureteroscopy carries particular value when a kidney-sparing plan is on the table. Someone with a single functioning kidney, kidney disease, tumors on both sides or other health conditions that make major surgery risky has the most to gain from knowing, before any organ is removed, whether the tumor is low-grade and small enough to treat through the scope.

Some people are asked to wait. An untreated urinary infection is the commonest reason, because instrumenting an infected tract can push bacteria into the bloodstream; the procedure is usually rescheduled once the infection is treated. People taking blood-thinning medicines need a plan agreed between the urologist and whoever prescribed the medicine, and that conversation belongs to those clinicians, never to a magazine. Pregnancy prompts a discussion about timing and imaging.

A smaller group may be advised to skip diagnostic ureteroscopy altogether. Where CT already shows an invasive-looking mass with hydronephrosis and cytology is high-grade, some guideline groups allow the team to proceed to removal of the kidney and ureter without a preliminary look, partly because observational studies have raised a question about whether ureteroscopy itself slightly increases later bladder recurrences. The evidence there is mixed and comes from non-randomized data, so practice varies. What does not vary is who decides: the treating team, with you, after weighing your kidney function, your other conditions and what the biopsy would realistically change.

Is a ureteroscopy a major surgery?

Surgeons file ureteroscopy under ‘minimally invasive,’ and by their yardstick it is. There is no incision. The scope follows the body’s own plumbing, the operation is typically completed in under an hour, and Cleveland Clinic notes that most people go home the same day. Compared with a nephroureterectomy, which removes an entire kidney and ureter and involves a hospital stay, it sits at the gentle end of the scale.

That framing can mislead patients, though, because minor for the surgeon is not the same as trivial for the body. Ureteroscopy is done under general anesthesia, or occasionally spinal anesthesia, so the usual pre-operative checks apply: fasting instructions, a review of medicines and allergies, and often a urine test to rule out infection. Many people wake with a stent in place and feel its presence for days. And the ureter is a delicate structure; the small risks of perforation, bleeding or later scarring are real, which is why it is performed in an operating room rather than an office.

Johns Hopkins describes the procedure as one that most people tolerate well, with burning on urination and pink-tinged urine for a short period afterward being common. Preparation is mostly logistical: arranging someone to drive you home, clearing a day or two of commitments, and asking in advance whether a stent is planned so the after-effects do not come as a surprise.

A useful way to hold both truths at once is this. On the day, ureteroscopy is a short outpatient procedure that will probably feel like a bad urinary infection for a while. In the bigger picture, it is a pivotal investigation, because the small piece of tissue it retrieves can be the difference between keeping a kidney and losing one. Neither half of that sentence should be dropped.

The day itself, step by step

You arrive fasted, usually a couple of hours before your slot, and meet the anesthesia team. A nurse checks your identity, allergies and medicines, and the surgeon confirms consent, including whether a laser might be used to treat the lesion during the same session if it looks small and low-grade. That last point matters: treatment in the same sitting happens only if it was agreed beforehand.

Once you are asleep, you are positioned with your legs supported in stirrups. The surgeon first passes a cystoscope to inspect the bladder and locate the ureteral opening on the relevant side. A fine guidewire is threaded up the ureter under X-ray guidance. Often a retrograde pyelogram is performed at this point, which means contrast dye is injected up the ureter and an X-ray image taken, giving a road map of the tube and the collecting system.

The ureteroscope then follows the wire. The surgeon advances slowly, irrigating with sterile fluid to keep the view clear, and examines the lining on the way up and again on the way down. At the lesion, urine is aspirated for cytology, and the biopsy instrument is passed down the working channel. Several samples are taken and placed in fixative for the laboratory. If the ureter is too narrow to admit the scope safely, the surgeon may place a stent and stop, planning to return after the tube has widened around it.

Finally, a ureteral stent, a soft hollow plastic tube running from kidney to bladder, is usually left in place to keep urine draining while the irritated ureter settles. Some stents have a string left outside the body for easy removal; others need a brief cystoscopy later. You wake in recovery, pass urine, receive written instructions and go home with your escort.

How the biopsy result sets the treatment plan: kidney-sparing care or removing the kidney and ureter

The pathology report does not arrive in isolation. Your urologist places it alongside the operative findings, the CT images and the cytology, and the combined picture is discussed by a multidisciplinary team, meaning a meeting of surgeons, oncologists, radiologists and pathologists. Major urology guidelines then sort upper-tract urothelial cancer into two broad groups, and the group determines which conversation you have next.

Feature	Points toward a lower-risk pathway	Points toward a higher-risk pathway
Number of tumors	Single	Multiple
Size	Smaller	Larger
Biopsy grade	Low-grade	High-grade
Urine cytology	Negative or low-grade	High-grade
CT appearance	No sign of invasion, no hydronephrosis	Invasive-looking mass or hydronephrosis
Shape seen at ureteroscopy	Papillary (frond-like)	Sessile (flat, broad-based)

A lower-risk picture opens the door to kidney-sparing treatment. The tumor may be destroyed with a laser through the ureteroscope, or a short diseased segment of ureter can be cut out and the ends rejoined, an operation called segmental ureterectomy. The trade-off is vigilance: guidelines pair kidney-sparing care with repeated ureteroscopies and imaging over years, because new tumors can appear elsewhere in the same lining.

A higher-risk picture usually leads to radical nephroureterectomy, removal of the kidney, the full length of the ureter and a cuff of bladder around its opening, since leaving any ureter behind leaves a place for recurrence. For higher-risk disease the oncology team may also discuss chemotherapy given into the bloodstream before or after surgery; whether, when and which class is a decision for the prescribing specialists based on kidney function and the final stage.

Neither pathway is fixed by the biopsy alone. A patient with a solitary kidney and a high-grade tumor, for instance, may still be offered kidney-sparing treatment because dialysis carries its own risks. The table describes tendencies, not rules.

Pain after ureteroscopy and the ureteral stent: what the following days and weeks usually look like

People ask how bad the pain will be, and the honest answer is that most describe irritation rather than pain. Cleveland Clinic and Johns Hopkins both list burning when passing urine, a frequent urge to go, and pink or light-red urine as expected for the first day or two. A dull ache in the flank on the treated side is also common, especially at the moment of urinating, because a stent lets a little urine flush back toward the kidney with each void. Your team will advise on comfort measures and any medicine; that advice, not this article, is the guide.

The stent tends to be the bigger complaint. It can cause bladder spasms, a sensation of incomplete emptying and occasional blood streaks for as long as it stays in. How long it stays is a decision for your surgeon and depends on how much the ureter was manipulated and whether a return visit is planned; it may be a few days or a few weeks. Ask before you leave, and make sure a removal date exists, because a forgotten stent can encrust with mineral deposits over time.

Drinking enough to keep urine pale helps dilute blood and reduce stinging. Light activity is encouraged; Cleveland Clinic notes that many people return to normal routines within a few days, though vigorous exercise can make stent symptoms flare and bleeding restart.

Then comes the wait for results. Ask when the pathology is expected and how it will be delivered, whether by phone, in clinic or through a patient portal. Many people find the waiting harder than the procedure. Writing down questions as they occur, and bringing someone to the results appointment, are small things that make a large difference to how much you actually hear.

Risks, limits and alternatives: what a ureteral biopsy can miss

Every procedure has a cost side of the ledger, and a neutral account of it is part of consent. The immediate risks of ureteroscopy are bleeding, urinary infection and injury to the ureter, ranging from a small tear that heals on a stent to, rarely, a perforation that needs further surgery. Weeks or months later, a stricture, which is a scar that narrows the ureter, can develop at the site of instrumentation and may itself need treatment. Anesthesia carries its own small risks, which the anesthesia team will discuss with you.

Then there are the limits of the information gained. A biopsy can miss the tumor entirely if the fragments are too small or land beside it. It can underestimate grade, as described earlier. It almost never establishes stage. A negative result in the face of a convincing CT lesion and positive cytology does not close the case; it usually prompts a repeat look or a decision to treat on the strength of the other evidence.

A theoretical concern deserves plain treatment. Some retrospective studies have reported more bladder recurrences after a diagnostic ureteroscopy, raising the possibility that tumor cells are shed and implant downstream. The finding is not consistent across studies and could reflect other differences between patients, so guideline bodies describe it as a possible association rather than a proven harm, and continue to recommend ureteroscopy when its result would change management.

Alternatives exist, and your team should be able to explain why one was or was not chosen. Proceeding straight to nephroureterectomy on the basis of imaging and cytology is one. For large tumors in the renal pelvis, a percutaneous approach, entering the kidney through the back with a small tract, allows bigger samples. Interval imaging is sometimes reasonable for an indeterminate shadow. Each carries its own trade-offs, and none is right for everyone.

What people often get wrong about ureteroscopy and ureteral tumors

The first misunderstanding is that a small biopsy means a small problem. Sample size reflects the anatomy of a thin tube, not the size or seriousness of what was found. A few millimeters of tissue can carry a high-grade diagnosis, and a generous sample can be entirely benign.

The second is that a negative biopsy rules out cancer. It does not, for the reasons already described: sampling error, crush artifact and mixed-grade tumors. Clinicians read the biopsy as one vote among several, and a persistent shadow on imaging keeps the question open.

The third is that any diagnosis of ureteral cancer means losing the kidney. Kidney-sparing treatment is an accepted option in lower-risk disease and in people whose kidney function cannot afford a loss, and it is precisely the biopsy that makes that option available. Conversely, some assume that if a laser has zapped the tumor, the matter is closed. Kidney-sparing care works only with long-term surveillance, because the same lining can grow new tumors.

A fourth myth runs the other way: that ureteroscopy is ‘just a camera’ and cannot hurt you. It carries genuine, if uncommon, risks, and it is done in an operating room for good reason.

Fifth, many people hear ‘rare’ and assume ‘nobody knows what to do.’ Rarity means some recommendations rest on weaker evidence, but risk stratification and the two broad treatment pathways are well established across guideline bodies.

Finally, some believe a clear urine test settles things. Cytology is strongest for high-grade cells and weakest for low-grade ones; a normal report lowers suspicion without ending the inquiry. Understanding what each test is good at, and what it is not, is the surest way to follow your own case with confidence.

What is the life expectancy for ureter cancer? An honest answer

It is the question nearly everyone types into a search bar the night after the phone call, and the honest answer begins with what the biopsy cannot tell you. Outlook in upper-tract urothelial cancer is driven chiefly by stage, that is, whether the tumor is confined to the lining, has grown into the muscle of the ureter wall, has passed through it, or has reached lymph nodes or distant organs. The National Cancer Institute’s patient summary states plainly that prognosis depends on the stage and grade of the tumor. A surface biopsy gives grade, and grade is a strong hint, but stage is usually established only on imaging and, most reliably, on the tissue removed at definitive surgery.

So a clinician looking at a biopsy report alone cannot responsibly give you a number, and any figure found online is a population average drawn from patients diagnosed years ago, mixed across every stage and age group. It describes a crowd, not you.

What can be said is directional. Low-grade, non-invasive tumors tend to behave indolently, and the main long-term concern is recurrence elsewhere in the urothelium rather than spread. High-grade or invasive tumors are treated more aggressively because they carry a higher chance of spreading, and the final surgical pathology, including lymph node status, is what the oncology team uses to discuss further treatment and follow-up.

Other things shape the conversation too: kidney function after treatment, age, heart and lung health, and whether a kidney-sparing approach was possible. Ask your team to walk through your own report line by line and to tell you which parts of the picture are still unknown. A good answer to the life expectancy question is specific, provisional and revisited as information arrives.

Questions to ask your care team

Consultations are short and the vocabulary is new, so it helps to arrive with a list. The questions below are the ones patients most often wish they had asked before ureteroscopy, and again when the results came back.

• Based on the CT and cytology, what do you think this is most likely to be, and how would the biopsy result change the plan?
• If the lesion looks small and low-grade during the procedure, might you treat it with a laser at the same time, and do I want that?
• Will I have a stent afterward, for how long, and how will it be removed?
• What should I expect in the first few days, and what would make you want to hear from me?
• When will the pathology be back, and how will I receive it?
• Is my case going to a multidisciplinary meeting, and can I have a written summary of its recommendation?
• Given my kidney function and other health conditions, is kidney-sparing treatment realistic for me, and what surveillance would it involve?
• If removal of the kidney and ureter is recommended, what would life with one kidney mean for me specifically?
• Do I have risk factors, such as smoking history or a family pattern, that should be addressed, and is genetic counseling relevant?
• Who is my point of contact between appointments?

Two habits make these questions work. Bring someone who can take notes while you listen, because most people retain only a fraction of what is said in a cancer consultation. And ask for the actual documents: the operative note, the pathology report and the imaging report. Reading them slowly at home, with the definitions in this article to hand, turns an overwhelming afternoon into something you can follow, and it makes the next conversation with your team far more useful for both sides.

When to call your doctor

Most recoveries from ureteroscopy are uneventful, but a short list of warning signs should prompt a same-day call to the urology team or, if they cannot be reached, a visit to urgent or emergency care. Fever or shaking chills after the procedure can signal a urinary infection spreading to the bloodstream, which needs prompt assessment. Heavy bleeding, meaning urine that is deep red, contains clots or does not lighten with fluids, is not the pink tinge that is expected. An inability to pass urine at all, or severe pain in the flank or lower abdomen that is not eased by the measures your team advised, may indicate a blocked or displaced stent. Persistent vomiting that prevents you from keeping fluids down also warrants a call.

Some situations are less urgent but still need attention within a day or two. If your stent has a string and it has been pulled or dislodged, tell the team. If a stent removal date has not been arranged or has been missed, chase it, because stents are not designed to stay in indefinitely. Burning or urgency that lasts well beyond the first few days, or new pain after a comfortable start, should be reported rather than endured.

Before the procedure, contact the team if you develop a fever, symptoms of a urinary infection, or a new illness, since ureteroscopy is generally postponed until an infection is treated. Ask them, rather than deciding yourself, about any medicine you are unsure whether to take on the day.

None of these signs is a diagnosis, and this list does not replace the written instructions you were given. It exists so that you recognize the moments when a phone call is the right move. The treating team knows your anatomy, your operation and your results; every decision about what to do next belongs with them.

Frequently asked questions

Is ureteroscopy major surgery?

No incision is made and most people go home the same day, so surgeons classify ureteroscopy as minimally invasive rather than major surgery. It still requires general or spinal anesthesia, is performed in an operating room, and carries small risks of bleeding, infection and injury to the ureter. Many people wake with a temporary stent that causes several days of urinary irritation. The safest mindset is to treat it as a short procedure with a meaningful recovery period.

How bad is the pain after ureteroscopy?

Most people describe burning when passing urine, urgency and a dull flank ache rather than severe pain, typically easing over the first day or two. A ureteral stent, if one is placed, is usually the main source of discomfort and can cause bladder spasms until it is removed. Severe pain that your team’s advice does not relieve, or pain with fever, is not expected and should prompt a same-day call.

How long does a ureteral stent stay in after ureteroscopy?

The duration is set by your surgeon and depends on how much the ureter was manipulated and whether a second procedure is planned; it can range from a few days to a few weeks. Some stents have a string for removal at home or in clinic, while others need a brief cystoscopy. Always leave the hospital knowing the removal plan, because a stent left too long can develop mineral encrustation.

Can a ureteral biopsy tell the stage of the cancer?

Usually not. Stage describes how deep the tumor has grown, and a ureteroscopic biopsy samples only the surface because the ureter wall is too thin to bite deeply without risking a hole. The biopsy therefore reports grade, meaning how abnormal the cells look. Stage is estimated from CT imaging and confirmed on tissue removed at definitive surgery, which is why your team may not give a stage until later.

Is urothelial cancer a rare cancer?

It depends on the site. Urothelial cancer of the bladder is common, but the same cancer arising in the ureter or renal pelvis is rare by comparison; the National Cancer Institute describes upper-tract transitional cell cancer as an uncommon disease. Rarity means fewer large trials, so some recommendations are borrowed from bladder cancer research. Risk factors include smoking, certain chemical exposures, aristolochic acid and Lynch syndrome.

What is the life expectancy for ureter cancer?

No honest number can be given from a biopsy alone, because outlook depends mainly on stage, which the biopsy usually cannot determine, as well as on grade, lymph node status, kidney function and general health. Low-grade non-invasive tumors tend to behave indolently, while high-grade or invasive tumors are treated more intensively. Ask your team to interpret your own reports and to say which parts remain unknown until surgery.

Can ureteroscopy spread the tumor?

Some retrospective studies have reported more bladder recurrences after diagnostic ureteroscopy, raising the possibility that tumor cells are shed and implant downstream. The finding is inconsistent across studies and may reflect other differences between patients, so guideline bodies treat it as a possible association rather than a proven harm. They continue to recommend ureteroscopy when its result would change treatment, and your team weighs this in deciding whether to look first.

What if the scope cannot reach the tumor?

A narrow ureter sometimes will not admit the scope safely. In that case the surgeon usually places a stent and stops; the stent gently widens the ureter over a short interval, and the procedure is repeated. Alternatives include relying on imaging and cytology to plan treatment, or, for large renal pelvis tumors, a percutaneous approach through the back. Your team will explain which option suits your anatomy and findings.

Do I need a ureteroscopy if the CT scan already shows a tumor?

Not always. When CT shows an invasive-looking mass with a swollen kidney and urine cytology is high-grade, some guidelines allow the team to proceed directly to removal of the kidney and ureter. Ureteroscopy with biopsy is most valuable when a kidney-sparing plan is being considered, when the diagnosis is uncertain, or when you have a single kidney or reduced kidney function. The decision rests with your treating team.

What does upper tract urothelial carcinoma biopsy grade mean?

Grade describes how abnormal the tumor cells appear under the microscope. Low-grade cells resemble normal lining and tend to grow slowly; high-grade cells look disorganized and are more likely to invade and spread. Because small samples can underestimate grade, clinicians read it alongside urine cytology, the tumor’s shape at ureteroscopy and CT findings. Grade is the main input the biopsy contributes to guideline risk stratification.

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.