URINE CYTOLOGY

Urine cytology is an examination of the urine under a microscope to analyze the abnormal cells in urine. Urine cytology is used along with other tests and procedures to diagnose urinary tract cancers. It is most often used to diagnose bladder cancer. The test may also detect for infection and inflammatory disease of the urinary tract. Urine cytology is better at detect larger and more aggressive urinary tract cancers than small urinary tract cancers that grow more slowly.

 Urine cytology test may recommend if any of these symptoms appear:

Blood in urine (hematuria). Burning during urination. Pain during urination. Female Urinary System Male Urinary System

 Each laboratory has its own way of describing the results of a urine cytology exam. Some common words used in pathology reports include:
Results Descriptions
Unsatisfactory Not enough cells or the wrong types of cells were found in specimen urine sample. May need to repeat the urine cytology test Negative Atypical No cancer cells were identified in urine sample. Some abnormalities were found in the cells in urine sample. But they were not abnormal enough to be considered cancer. Urine cells were abnormal and may be cancerous. Cancer cells were found in urine sample.

Suspicious Positive

 A urine cytology test cannot be used alone to diagnose cancer. If atypical or cancerous cells are detected, a cystoscopy procedure or computerized tomography (CT) scan may be recommend to examine the bladder and urinary tract for abnormalities.
Female Cystoscopy Male Cystoscopy

URINE COLLECTION FOR CYTOLOGY

Urine cytology is useful in diagnosing diseases that involve the mucosal surface. Knowing the type of exfoliated urinary tract specimen is essential. Therefore, clinical information should include whether the specimen is voided, catheterization or a bladder washing. The clean-catch voided urine is recommended for screening purpose. But if suspecting bladder malignancy, bladder washing is preferred. It is important that no alcohol or any other preservatives are added to the specimen. Fresh is the most desirable specimen.

Voided Urine
Voided urine should be obtained 3-4 hours after the patient has last urinated. Early morning urine specimen must be avoided because cells held overnight in the bladder may be degraded and cannot be used for urine cytology. In women, voided urine may be contaminated by vaginal cells but in most cases this does not affect a diagnosis. Thus, a midstream (clean-catch) specimen is recommended to ensure the adequacy of the sample. The clean-catch urine method is used to prevent germs from the penis or vagina from getting into a urine sample. The minimum amount of urine necessary to ensure adequate cellularity may be as high as 25-100ml. A special clean-catch urine kit that contains sterile wipes may be given.

Voided Urine
Female Patients
With the forefingers, spread the outer folds of the labia (vagina lips). With the other hand, firmly wipe from front to back on one side of the fold with the first sterile wipe and discard. With the second wipe, wipe the other side from front to back and discard. With the third wipe, wipe the center (urethral) area from front to back and discard.

Male Patients
Clean the urethral opening (head) of the penis with a sterile wipe. If uncircumcised, retracting the foreskin, carefully wipe from front to back with a sterile wipe. Use a sterile wipe only once and discard.

Wash hands with soap and water and dry them on a clean towel

Collect midstream urine in a container. Place the lid on the container securely. Label the sample with the patient name. Refrigerate if the sample will not be delivered to the laboratory within one hour.

Catheterized Urine
Specimen obtained by catheterization have disadvantages:
Catheterization cainfectionrries a risk of urinary tract. Urine collected from an indwelling catheter is often a pooled specimen that has been at room temperature for many hours and cellular degeneration can be occurred. The tip of the catheter often scrapes off benign urothelial cell clusters which mimic the appearance of a papillary neoplasm.

The urinary catheterization procedure should be carried out by a nurse or doctor.

Catheterized Urine
Female Patients
Clean the urethral area carefully. Spread open the labial folds. Clean the vaginal area from front to back with a sterile wipe. Use a sterile wipe only once and discard

Male Patients
Clean the urethral area carefully. Clean the urethral opening of the penis. If uncircumcised, retracting the foreskin, carefully wipe from front to back with a sterile wipe. Use a sterile wipe only once and discard.

Pass the catheter into the bladder using a sterile technique. Discard the first 15-20 ml of urine that passes through the mouth of the catheter. Collect the urine in a sterile sample cup. Place the lid on the container securely. Label the sample with the patient name. Refrigerate if the sample will not be delivered to the lab within one hour.

Bladder Washing
Bladder washing is obtained through a catheter by irrigating the bladder with 5 to 10 pulses of 50ml of sterile normal saline.
Produce a cellular suspension of freshly exfoliated epithelial cells.

The advantages of bladder washing over voided urine are:

Better cellular preservation. Greater cellularity. Less chance of contamination by background debris.

Place specimen in clean container and bring to laboratory immediately. If unable to bring immediately, place in refrigerator until it is brought to the laboratory.

Relative Advantages and Disadvantages of Urine Specimen Types

Specimen Types
Voided urine

Advantages
Non-invasive No instrumentation artifact High cellularity

Disadvantages
Low cellularity Vaginal contamination Poor preservation Invasive Instrumentation artifact Poor preservation Invasive Instrumentation artifact

Cathetherized

Bladder washing

High cellularity Good cell preservation

References
Urine Cytology. (2011). Mayo Clinic. Retrieved November 16, 2013 from http://www.mayoclinic.com/health/urinecytology/MY00948 Urine Collection for Cytology. (2003). Pocono Health System. Retrieved November 16, 2013 from http://www.pmclab.org/manual/7CytologySpecime nCollection_2a.pdf Urinary Tract Cytology. (2013). Cytology Stuff. Retrieved November 16, 2013 from http://www.cytologystuff.com/study/nongynintro3. htm