Indication of Urine Cytology

Urine is an acellular liquid product of renal excretory function. As liquid passes

through the renal tubules, renal pelvis, ureter, urinary bladder, and urethra, it picks
up desquamating cells derived from the epithelia of these organs. Infl ammatory
cells, erythrocytes and macrophages are frequently seen. Voided urine has an acid
pH and a high content of urea and other organic components; therefore it is not
isotonic. Consequently, urine is not a hospitable medium for desquamated cells,
which are often poorly preserved and sometimes diffi cult to access
microscopically.1
The principal indications for use of cytology in disorders of the lower urinary tract
(bladder, urethra, ureters, and renal pelves) are as follows:1
1. The diagnosis of high grade urinary cancers, most importantly, flat carcinoma
in situ; the cytologic techniques are of a very limited value in the identifi cation of
well-differentiated (low grade) papillary tumors. Urine cytology is being used for
the early detection and surveillance of urothelial carcinoma, although it is less
useful than cystoscopy and other urinebased tests for low-grade tumours.
However, it is extremely valuable in the detection of high-grade transitional cell
carcinomas. Moreover, there is a high institutional variability in the diagnostic
accuracy of urine cytology in detecting urothelial bladder cancer. Scepticism
about its low sensitivity, thereby missing a significant number of cancers, is also a
problem. Several new ancillary diagnostic techniques are under investigation,
many of which have excellent sensitivity, particularly in their ability to detect lowgrade tumours. The sensitivity of these tumour markers is reported to be times
greater than cytology. Despite excellent sensitivity, the low specificity and low
positive predictive value limit the usefulness of these tumour markers.2
2. Routinely used in the follow-up of patients with a history of bladder cancer
because close monitoring of patients is essential for the early detection of
recurrences. The current standard of care consists of cystoscopy and cytology
every 36 months for the fi rst year and at reduced intervals subsequently. For the

upper urinary tract, cytologic techniques serve to may identify the nature of spaceoccupying lesions.
3. Patient with haematuria symptop.
Sitasi
1. Koss L, Hoda R. Koss's cytology of the urinary tract with histopathologic
correlations. New York: Springer; 2012.
2. Raab SS, Grzybicki DM, Vrbin CM, Geisinger KR. Urine cytology
discrepancies: frequency, causes, and outcomes. Am J Clin Pathol
2007;127:94653.