Urinary cytology is a diagnostic technique used to examine cells shed from the urinary tract, including the kidneys, ureters, bladder, and urethra. These cells are collected from urine samples and examined under a microscope to detect abnormalities indicative of various conditions, such as urinary tract infections, inflammation, or cancers like bladder cancer. Urinary cytology is often employed as a non-invasive screening tool to aid in the early detection and monitoring of urinary tract diseases. It plays a crucial role in the diagnostic process alongside other imaging studies and clinical evaluations.

What is urinary cytology?

Urinary cytology is a medical procedure that involves the examination of cells shed from the urinary tract. These cells are collected from urine samples provided by the patient. The collected cells are then analyzed under a microscope by a cytotechnologist or pathologist to identify any abnormalities.

The main purpose of urinary cytology is to detect signs of diseases affecting the urinary tract, such as urinary tract infections, inflammation, and cancers like bladder cancer. By examining the cellular characteristics, including the size, shape, and arrangement of cells, healthcare providers can assess the presence of abnormal cells indicative of disease.

Urinary cytology is often used as a non-invasive screening tool, especially in cases where there is suspicion of urinary tract abnormalities or in monitoring patients with a history of urinary tract conditions. However, it is important to note that urinary cytology may not always provide definitive results, and additional tests or procedures may be required for confirmation or further evaluation.

How to do?

Performing urinary cytology involves several steps:

Sample Collection: A clean-catch midstream urine sample is typically collected from the patient. The patient is instructed on proper hygiene techniques to avoid contamination of the sample.

Sample Processing: The urine sample is centrifuged to concentrate the cells present in the urine sediment. This helps to increase the likelihood of detecting abnormal cells.

Preparation of Slide: A cytotechnologist or pathologist takes a small portion of the concentrated sediment and spreads it onto a glass slide. The cells are then fixed onto the slide using a fixative solution such as alcohol.

Staining: The slide is then stained using special dyes, such as Papanicolaou (Pap) stain or hematoxylin and eosin (H&E) stain. Staining helps to enhance the visibility of cellular structures and abnormalities.

Microscopic Examination: The stained slide is examined under a microscope by a cytotechnologist or pathologist. They look for abnormal cellular characteristics, such as changes in cell size, shape, and nuclear features.

Interpretation: The cytotechnologist or pathologist interprets the findings based on established criteria for normal and abnormal cells. They classify the cells as benign, suspicious, or malignant based on their appearance.

Reporting: A report summarizing the findings of the urinary cytology examination is generated. The report includes the interpretation of the cellular characteristics and any recommendations for further evaluation or follow-up.

It’s essential to follow standardized protocols and quality control measures throughout the process to ensure accurate and reliable results. Additionally, urinary cytology results are often interpreted in conjunction with other clinical findings and diagnostic tests to provide a comprehensive assessment of the patient’s urinary tract health.

Indications

Urinary cytology is indicated in several clinical scenarios to aid in the diagnosis and management of various urinary tract conditions. Some common indications for urinary cytology include:

Screening for Bladder Cancer: Urinary cytology is often used as a non-invasive screening tool for detecting bladder cancer, especially in high-risk individuals with a history of smoking, exposure to certain chemicals, or prior radiation therapy.

Monitoring of Bladder Cancer: Urinary cytology may be performed periodically to monitor patients with a history of bladder cancer for recurrence or progression of the disease.

Evaluation of Hematuria: Hematuria, or blood in the urine, can be a sign of various urinary tract conditions, including bladder cancer. Urinary cytology may be ordered to investigate the presence of abnormal cells in the urine of patients with unexplained hematuria.

Assessment of Urinary Tract Infections (UTIs): Urinary cytology may be used to evaluate the presence of inflammatory cells, bacteria, or other indicators of infection in patients with suspected UTIs.

Diagnosis of Other Urinary Tract Disorders: Urinary cytology may be indicated in the evaluation of other urinary tract disorders, such as interstitial cystitis, nephritis, and urethral abnormalities.

Surveillance of High-Risk Populations: Individuals with a family history of bladder cancer or genetic predisposition to urinary tract malignancies may undergo regular urinary cytology screening as part of surveillance protocols.

Pre-operative Evaluation: Urinary cytology may be performed as part of the pre-operative evaluation in patients undergoing procedures such as cystoscopy or transurethral resection of bladder tumors (TURBT) to assess the presence of cancerous cells.

Follow-up after Treatment: Patients undergoing treatment for urinary tract malignancies, such as chemotherapy or immunotherapy, may undergo urinary cytology to monitor treatment response and detect disease recurrence.

Overall, urinary cytology is a valuable diagnostic tool that can provide important information about the health of the urinary tract and aid in the early detection and management of various urinary tract conditions, particularly bladder cancer.

Summary

Urinary cytology is a diagnostic procedure used to examine cells shed from the urinary tract. It involves collecting a urine sample from the patient, processing it to concentrate the cells, and preparing slides for microscopic examination. The stained slides are then examined by cytotechnologists or pathologists to identify abnormal cellular characteristics, which can indicate conditions such as urinary tract infections, inflammation, or bladder cancer. Urinary cytology is commonly employed for screening, diagnosis, and monitoring of urinary tract disorders, especially bladder cancer. It is a non-invasive procedure that plays a crucial role in early detection and management of urinary tract diseases, often used in conjunction with other clinical evaluations and diagnostic tests.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul-TURKEY