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Microscopic chromocystoscopy is a new in vivo procedure that we have developed to aid in the detection and treatment of bladder tumors. Intravesical ionic dye chromocystoscopy was introduced by our group to permit cystoscopic viewing with ordinary light of selectively stained malignant urothelial surfaces by the cationic dye, methylene blue. With the recent availability of the Hamou hysteroscope, a microscopic endoscope, we have combined intravesical ionic dye chromocystoscopy with microscopic cystoscopy to give in vivo urothelial surface histology, with resolution of cytological detail. We herein describe our new method and preliminary results with this procedure, which we have designated in vivo urothelial surface histology by microscopic chromocystoscopy.

The availability of extended-length, small-caliber endoscopes allows the use of many cystoscopic techniques in the ureter and renal pelvis. Although the instruments are rigid, they can be passed transurethrally in both male and female patients to allow the urologist to diagnose and treat many lesions of the upper urinary tract. The success of our series demonstrates the utility and safety of the technique, which often eliminates the need for surgical exposure of the lesions.

Transurethral endoscopic access to the upper urinary tract using rigid optics is evolving into a significant addition to the specialty of urology. The basic endoscopic expertise urologists have perfected for use in the urethra, prostate, and bladder is readily transposed to the ureter and renal pelvis. Indications, precautions, instrumentation, and procedural techniques are detailed.

The technique of transurethral ureteropyeloscopy allows many standard cystoscopic procedures to be extended into the upper urinary tract. This endoscopic method was used to evaluate 31 patients suspected to have urothelial malignancies of the ureter or renal pelvis. Twenty-eight of the patients had the procedure successfully completed (90%), 11 of whom were found to have urothelial tumors. Diagnostic ureteroscopic biopsy in three of these patients revealed high-grade, multifocal tumors and was followed by nephroureterectomy (two patients) or partial ureterectomy (one patient). However, in eight patients, ureteroscopy and biopsy revealed apparently localized, low-grade tumors which were treated by ureteroscopic fulguration or resection. The latter patients have undergone endoscopic surveillance every 3 months (average follow-up, 21 months). The technique of ureteropyeloscopy permits endoscopic access into the ureter and renal pelvis, enabling tissue diagnosis and better preoperative cancer staging without surgical exploration. Although follow-up is short, selected patients with low-grade tumors may be treated primarily by endoscopic means.