Urine Cytology

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Specimen:

Random collection specimen, voided or catheterized; intraoperative washings of urinary bladder, ureters, or renal pelvis.
Volume: 20mL. Minimum volume:5 ml.

Container:

Capable plastic container.

Special Instructions:

• A first morning voided specimen is not suitable, because of cellular degeneration.
• Bladder washings should not be collected in a hypotonic solution.
• Do not send 24 hour collections.
• If specific sites are sampled, label specimen and requisition appropriately.
• Indicate whether the specimen is voided or catheterized.
• If patient is menstruating, write “menstruating” on the requisition.
• Information regarding type of specimen, admitting diagnosis, and pertinent clinical history (i.e., age, clinical impression, past diagnosis, radiographic findings, and history of radiation or chemotherapy) is essential to interpretation and should be noted on the requisition.
• Clinical evidence of immunosuppression should be indicated where appropriate.
• Special handling requirements (isolation) should be clearly noted on the requisition.

Patient Preparation:

• Patient should not have had mineral oil cathartics.

Collection Technique:

• Ideally, specimen should be as fresh as possible. Urine which has been in the bladder for prolonged periods shows extensive cellular degeneration.
• For detection of upper urinary tract lesions: Catheterize ureters to pelvis for suspected renal or pelvic lesions. Repeat procedure using either ureter for control. Collect urine for 30 minutes.
• Use a Clean Catch procedure for voided specimens.
• Label specimen container with patient’s name, date, and time of collection. Indicate specimen type; right and left ureteral, or right and left pelvic specimen on the container.
• Deliver to the Laboratory immediately.
• If the specimen cannot be brought to the laboratory in a timely manner, the specimen should be mixed with an equal volume CytoLyt solution and kept refrigerated. Note on the Cytology Request form when CytoLyt has been added.

Request Form:

• Complete a Cytology Request form as indicated in the Test Ordering section of this manual. The patient information as well as the Non-Gyn Cytology portion of the form should be completed.

Causes for Rejection:

• Specimen container not properly identified.
• 24 hour collection.
• Excessive delay in transport.
• Prolonged period at room temperature.
• Contaminated container.

Limitations:

• Low grade papillary transitional cell carcinomas may not be diagnosed by cytologic examination.
• Recent instrumentation and calculi may produce atypical changes in urothelial cells simulating malignancy.
• Numerous chemotherapeutic agents produce cell changes that may mimic urothelial abnormalities.

Additional Information:

• Voided urine is much preferred over a catheterized sample due to atypical cell changes caused by trauma.
• Although poorly-differentiated cancers are diagnosed with relative ease, well-differentiated neoplasms may not be diagnosed by routine methods. Detection of aneuploid cell lines or increased proliferative fraction by flow cytometry may help in this dilemma.