Abstract:Objective To investigate the application and diagnostic value of ureteroscopy combined with real-time fluorescence quantitative polymerase chain reaction （FQ-PCR） in atypical renal tuberculosis. Methods A retrospective analysis was performed on the diagnosis and treatment data of 43 patients with atypical renal tuberculosis （who were diagnosed renal tuberculosis after admission） admitted to Hebei Chest Hospital from July 2015 to July 2020. The detection rates of renal tuberculosis were compared between three methods such as acid fast staining of urinary sediment and renal pelvis urine, Mycobacterium tuberculosis culture and FQ-PCR-tuberculosis deoxyribonucleic acid (TB-DNA). Ureteroscopy and tissue biopsy were performed. Results The positive rates detected by FQ-PCR-TB-DNA, Mycobacterium tuberculosis culture and acid-fast staining were 60.47%, 20.93% and 4.65% in urine sediment，and 93.02%, 76.74% and 41.86% in renal pelvis urine ,respectively. The differences among three methods were statistically significant（P＜0.01）. The positive rates in urine from renal pelvis were significantly higher than those in urinary sediment,respectively by acid fast staining （41.86% vs 4.65%, P＜0.01）, Mycobacterium tuberculosis culture method（76.74% vs 20.93%，P＜0.01） and FQ-PCR-TB-DNA method（93.02% vs 60.47%, P＜0.01）. Ureteroscopic biopsy in 39 cases showed 90.70% of tuberculosis and 9.30% of chronic inflammation. The detection rate of renal tuberculosis in renal pelvis urine by ureteroscopy combined with FQ-PCR was significantly higher than that in urinary sediment （100% vs 60.47%, P＜0.01）. The main complications of ureteroscopy were new gross hematuria（18 cases） and urinary frequency（14 cases）. Conclusion Ureteroscopy combined with FQ-PCR can significantly increase the clinical detection rate of atypical renal tuberculosis and can be applied selectively.