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Urine cytology

Urine cytology is a test to look for abnormal cells in your urine. Urine cytology is used along with other tests and procedures to diagnose urinary tract cancers.

Urine cytology is most often used to diagnose bladder cancer, though it may also detect cancers of the kidney, prostate, ureter and urethra.

Your doctor may recommend a urine cytology test if blood has been detected in your urine (hematuria).

Urine cytology may also be used in people who have already been diagnosed with bladder cancer and have undergone treatment. In these cases, a urine cytology test may help detect a bladder cancer recurrence.

Most of the time, the sample is collected as a clean catch urine sample in your doctor's office or at home. This is done by urinating into a special container. The clean-catch method is used to prevent germs from the penis or vagina from getting into a urine sample. To collect your urine, you may get a special clean-catch kit from your health care provider that contains a cleansing solution and sterile wipes. Follow instructions exactly so that the results are accurate.

The urine sample can also be collected during cystoscopy. During this procedure, your provider uses a thin, tube-like instrument with a camera on the end to examine the inside of your bladder.

Abnormal cells in the urine may be a sign of inflammation of the urinary tract or cancer of the kidney, ureters, bladder, or urethra.

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What is urine cytology ?

Urine cytology is a test to look for abnormal cells in your urine. Urine cytology is used along with other tests and procedures to diagnose urinary tract cancers.
Urine cytology is most often used to diagnose bladder cancer, though it may also detect cancers of the kidney, prostate, ureter and urethra.

Your doctor may recommend a urine cytology test if blood has been detected in your urine (hematuria).

Urine cytology may also be used in people who have already been diagnosed with bladder cancer and have undergone treatment. In these cases, a urine cytology test may help detect a bladder cancer recurrence.

Why it's done

Urine cytology is used along with other tests and procedures to diagnose cancers of the urinary tract, including:
Bladder cancer
Cancer of the ureter
Cancer of the urethra
Urine cytology can best detect larger and more-aggressive urinary tract cancers. Urine cytology might not detect small urinary tract cancers that grow more slowly.

Risks

Risks of urine cytology testing depend on how your urine is collected. Most often urine is collected by urinating into a sterile container, which carries no risk.

If your urine is collected by inserting a hollow tube (catheter) into your urethra, there is a risk of urinary tract infection. Ask your doctor about the specific risks of your procedure.

How you prepare

To prepare for your urine cytology test, try to schedule your test for sometime after your first morning urination.
Urine eliminated during your first morning urination can't be used for urine cytology. Cells held overnight in your bladder may be degraded, making them difficult to analyze in the laboratory.

What you can expect

Collecting a urine sample for testing

A urine cytology test requires a urine sample. Most often this is obtained by urinating into a sterile container. In some cases, a urine sample is collected using a thin, hollow tube (catheter) that's inserted into your urethra and moved up to your bladder.

Examining the urine sample in the laboratory

Your urine sample is sent to a laboratory for testing by a doctor who specializes in examining body tissues (pathologist). The pathologist analyzes any cells seen in the urine sample under a microscope. The pathologist notes the types of cells and looks for signs in the cells that might indicate cancer.

Results

The pathologist will send the results of your urine cytology test to your doctor, who will report the results to you.

Ask your doctor how long you can expect to wait for your results.

Each laboratory has its own way of describing the results of a urine cytology exam. Some common words used in pathology reports include:

Unsatisfactory specimen. This may mean that not enough cells or the wrong types of cells were found in your urine sample. You may need to repeat the urine cytology test.
Negative. This means no cancer cells were identified in your urine sample.
Atypical. This indicates some abnormalities were found in the cells in your urine sample. But while the cells weren't normal, they weren't abnormal enough to be considered cancer.
Suspicious. This term may indicate that urine cells were abnormal and may be cancerous.
Positive. A positive result indicates that cancer cells were found in your urine.
A urine cytology test can't be used alone to diagnose cancer.

If atypical or cancerous cells are detected using urine cytology, your doctor will likely recommend a cystoscopy procedure and a computerized tomography (CT) scan to examine your bladder and urinary tract for abnormalities.

Blood in urine facts

Blood in urine can sometimes be visible only with a microscope.
Evaluating blood in urine requires consideration of the entire urinary tract.
Tests used for the diagnosis of blood in urine may include a CT scan, cystoscopy, ultrasound, IVP, MRI, urine culture, and urine cytology.
Management of blood in the urine depends upon the underlying cause.

What is blood in urine (hematuria)?

Hematuria, or blood in the urine, can be either gross (visible) or microscopic (blood cells only visible through a microscope). Gross hematuria can vary widely in appearance, from light pink to deep red with clots. Although the amount of blood in the urine may be different, the types of conditions that can cause the problem are the same, and require the same kind of workup or evaluation.

People with gross hematuria will visit their doctor with this as a primary complaint. People who have microscopic hematuria, on the other hand, will be unaware of a problem and their condition will most commonly be detected as part of a periodic checkup by a primary-care physician.

What are the causes of blood in urine?

The causes of gross and microscopic hematuria are similar and may result from bleeding anywhere along the urinary tract. One cannot readily distinguish between blood originating in the kidneys, ureters (the tubes that transport urine from the kidneys to the bladder), bladder, or urethra. Any degree of blood in the urine should be fully evaluated by a physician, even if it resolves spontaneously.

Infection of the urine, (often called a urinary tract infection or UTI) stemming either from the kidneys or bladder, is a common cause of microscopic hematuria. Urine is naturally sterile and should not contain bacteria. Kidney and bladder stones can cause irritation and abrasion of the urinary tract, leading to microscopic or gross hematuria. Trauma affecting any of the components of the urinary tract or the prostate can lead to bloody urine. Hematuria can also be associated with renal (kidney) disease, as well as hematologic disorders involving the body's clotting system. Medications that increase the risk of bleeding, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix), may also lead to bloody urine. Lastly, cancer anywhere along the urinary tract can present with hematuria.

How is blood in urine diagnosed?

The evaluation for blood in urine consists of taking a history, performing a physical examination, evaluating the urine with a chemical test strip and under a microscope, and obtaining a culture of the urine to identify any bacteria present. Lower urinary tract symptoms, such as urgency (feeling a strong need to urinate) and frequency (needing to urinate frequently), as well as the presence of fever or chills, are suggestive of infection. Recent trauma, even if believed by the patient to have been inconsequential, should be considered as a potential cause. Abdominal or flank pain, especially if radiating to the inguinal or the genital area, may suggest ureteral or kidney stones. All recent medications, including vitamins or herbal supplements, should be reviewed with the health-care professional. However, it is important to note that even if the patient has been taking a medication that is associated with bleeding, a full workup (as listed below) should still be undertaken.

The physical exam will focus on possible sources of hematuria. Bruising over the back or abdomen may indicate trauma. A digital rectal exam should be performed, especially in males, as findings consistent with prostatitis (for example, tenderness on palpation of the prostate) or an enlarged prostate suggestive of benign prostatic hyperplasia (BPH), may be useful in making a diagnosis. The finding of a nodule or an area of induration of the prostate may be indicative of cancer. A repeat urinalysis, as well as a urine culture, should be obtained. The presence of white blood cells on urinalysis is more consistent with a urinary tract infection. Protein, glucose, or sediment in the urine may indicate the presence of a disease of the kidneys. Blood tests are also important, as they will aid in assessing renal function and identifying any clotting abnormalities.

In addition to the basic history and physical exam, there are three additional components for any workup of hematuria: imaging, urine cytology, and cystoscopy.

The CT scan is an imaging evaluation of the urinary tract. Prior to the procedure, the patient drinks an oral contrast agent and a dye is injected intravenously. The patient then goes through the CT scan machine and images are taken of the abdomen and pelvis. Another test that can be performed, the intravenous pyelogram (IVP), is also a type of X-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of X-rays are then taken over a 30-minute period to look for abnormalities. The CT scan is more commonly performed than the IVP to evaluate the urinary tract and should be considered the test of choice. Both of these studies are especially useful for evaluating the kidneys and ureters, but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. This is a simple 10-minute procedure using a thin, flexible cystoscope (or fiberoptic camera) is inserted via the urethra into the bladder to directly visualize any lesions or sources of bleeding. This is usually done with local anesthetic jelly injected into the urethra. Finally, urine cytology involves giving a urine sample to be analyzed by a pathologist for the presence of cancerous or abnormal-appearing cells.

How is blood in urine treated?

Treatments for hematuria vary widely and depend on the reason for the bleeding. It is important to note that quite often no cause is found for the hematuria. This should not be a source of major concern, however, since an appropriate workup effectively rules out the most serious causes of hematuria (for example, cancer). In cases where a workup is negative and the cause of the hematuria remains unknown, observation with repeat urinalyses is a reasonable option. A blood test to check kidney function and a blood-pressure check should be done as well. Caucasian men over 50 should discuss with their doctor an annual prostate-specific antigen (PSA) blood test which is used to screen for prostate cancer. Prostate screening in African Americans traditionally begins at age 45 and in all races, a history of prostate cancer in close family members may indicate an earlier start of screening.

Further discussion of the treatment for hematuria would depend upon the results of the workup and the exact cause for the hematuria. The urologist who performs this examination is responsible for recommending any further treatment or workup that would be necessary.

Why Do I Need Urine Cytology?

Your doctor may order a urine cytology exam if you have any of these symptoms:

unexplained blood in your urine
burning during urination
persistent pain during urination
The test also monitors patients who have had urinary tract infections or cancer or who are at high risk for bladder cancer. It can also detect a variety of viral diseases.

What Is the Procedure for Urine Cytology?

There are two ways to obtain the cells needed for a cytology exam. Your doctor can collect a sample during a cystoscopy, which is an examination of the inside of the bladder, or you can provide a clean catch urine sample.

Cystoscopy
A cystoscopy is performed using a cystoscope, a thin tube with a small camera on the end. The procedure takes between 10 and 20 minutes.

Because the urine from your first morning urination remains in your bladder for many hours through the night, the cells may degrade and not be useful for urine cytology. However, this doesn’t mean you should urinate right before the test. In fact, you may need to hold urine in your bladder for a few hours prior to a cystoscopy. Be sure to ask your doctor for specific instructions before the test.

For a cystoscopy, your doctor will clean the skin around your urethra (tube coming out from the bladder) and use a topical gel to numb the area. They will insert the cystoscope into your urethra and up into your bladder. You may feel some pressure and an urge to urinate. Your doctor will drain your urine into a sterile container, and then remove the catheter.

The procedure carries a small risk of infection or bleeding. Your doctor will send the urine sample to a laboratory for analysis, and then will receive a report.

Clean Catch Urine Sample
A clean catch urine sample is easy, noninvasive, and carries no risk. Otherwise known as a midstream urine sample, you can do a clean catch urine sample in a doctor’s office or in the comfort of your own home.

Your doctor’s office will provide a special container to collect the sample. Be sure to ask your doctor for specific instructions regarding the proper way to get the sample and where to bring it when you finish. Failure to follow instructions may provide a poor result, and you may have to repeat the test.

You will use special cleansing cloths to clean the skin around your urethra prior to the test. You will need to urinate a small amount into the toilet, and then stop the flow of urine. Then you will urinate into the sterile container until reaching the desired level. You may then finish urinating into the toilet.

In some cases, your doctor may want you to provide urine samples over the course of several days. Your doctor will send the urine sample to a laboratory for analysis, and then will receive a report.

What Happens in the Laboratory?

A pathologist will analyze the cells under a microscope to see if there are any abnormalities. They may also look at the cells in a culture dish to see if bacteria or other organisms are growing.

The pathologist will send the results of your urine cytology test to your doctor, who will report the results to you. Ask your doctor how long you can expect to wait for your results.

What Do the Test Results Mean?

Different laboratories use different language in their reports. Your doctor will be able to explain what your results mean. There are some common terms that can describe your results.

Negative
If your urine cells appear normal and are free of bacteria and yeast, this is a normal result. Most labs will call this a “negative” result.

Unsatisfactory
The lab may label your specimen “unsatisfactory” if there weren’t enough usable cells in the sample. In this case, you will likely have to repeat the procedure and provide a new sample.

Atypical or Suspicious
These terms describe when cells don’t appear normal, but it can’t be confirmed that they are cancerous or precancerous.

Positive
If bacteria or yeast are present in the culture, you probably have a bladder or urinary tract infection. Antibiotics can usually treat these conditions.

Cells that appear abnormal in your urine may also indicate inflammation in the urinary tract or cancer of the bladder, kidney, ureter, or urethra. However, an abnormal urine cytology result can’t diagnose these diseases. Additional tests are usually necessary to confirm the diagnosis.