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Routine urine cytology has no role in hematuria investigations

Routine urine cytology has no role in hematuria investigations
Routine urine cytology has no role in hematuria investigations

Purpose: urine cytology has been a long-standing first line investigation for hematuria and is recommended in current major guidelines. We determined the contribution of urine cytology in hematuria investigations and its cost implications.

Materials and methods: data were prospectively collected for 2,778 consecutive patients investigated for hematuria at a United Kingdom teaching hospital from January 1999 to September 2007 with final analysis in October 2010. All patients underwent standard hematuria investigations including urine cytology, flexible cystoscopy and renal tract ultrasound with excretory urogram or computerized tomography urogram performed in those with visible hematuria without a diagnosis after first line tests. Patients with positive urine cytology as the only finding underwent further cystoscopy, retrograde studies or ureteroscopy with biopsy under general anesthesia. Outcomes in terms of eventual diagnosis were cross-referenced with initial urine cytology results (classified as malignant, suspicious, atypical, benign or unsatisfactory). Costs of urine cytology were calculated.

Results: if the patients 124 (4.5%) had malignant cells and 260 (9.4%) had atypical/suspicious results. For urothelial cancer cytology demonstrated 45.5% sensitivity and 89.5% specificity. Two patients with urine cytology as the only positive finding had urothelial malignancy on further investigation. For the entire cohort the cost of cytology was £111,120.

Conclusions: routine urine cytology is costly and of limited clinical value as a first line investigation for all patients with hematuria, and should be omitted from guidelines.

Adult, Diagnostic Tests, Routine, Female, Hematuria, Humans, Male, Prospective Studies, Urine, Urologic Neoplasms, Journal Article
0022-5347
1255-1258
Mishriki, Said F
1cdff697-8825-49da-9432-c385f4a2c415
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce
Vint, Ross
67577729-fb42-4885-aed1-56a332aa9cca
Grimsley, Samuel J S
59fbb6a7-43e8-4dd1-ad21-3f84b5dae508
Lam, Thomas
61f506bc-674c-4a03-ab87-fb60c8ae77d1
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Mishriki, Said F
1cdff697-8825-49da-9432-c385f4a2c415
Aboumarzouk, Omar
3c7e2433-638d-4378-9931-902fdc68acce
Vint, Ross
67577729-fb42-4885-aed1-56a332aa9cca
Grimsley, Samuel J S
59fbb6a7-43e8-4dd1-ad21-3f84b5dae508
Lam, Thomas
61f506bc-674c-4a03-ab87-fb60c8ae77d1
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Mishriki, Said F, Aboumarzouk, Omar, Vint, Ross, Grimsley, Samuel J S, Lam, Thomas and Somani, Bhaskar (2013) Routine urine cytology has no role in hematuria investigations. The Journal of Urology, 189 (4), 1255-1258. (doi:10.1016/j.juro.2012.10.022).

Record type: Article

Abstract

Purpose: urine cytology has been a long-standing first line investigation for hematuria and is recommended in current major guidelines. We determined the contribution of urine cytology in hematuria investigations and its cost implications.

Materials and methods: data were prospectively collected for 2,778 consecutive patients investigated for hematuria at a United Kingdom teaching hospital from January 1999 to September 2007 with final analysis in October 2010. All patients underwent standard hematuria investigations including urine cytology, flexible cystoscopy and renal tract ultrasound with excretory urogram or computerized tomography urogram performed in those with visible hematuria without a diagnosis after first line tests. Patients with positive urine cytology as the only finding underwent further cystoscopy, retrograde studies or ureteroscopy with biopsy under general anesthesia. Outcomes in terms of eventual diagnosis were cross-referenced with initial urine cytology results (classified as malignant, suspicious, atypical, benign or unsatisfactory). Costs of urine cytology were calculated.

Results: if the patients 124 (4.5%) had malignant cells and 260 (9.4%) had atypical/suspicious results. For urothelial cancer cytology demonstrated 45.5% sensitivity and 89.5% specificity. Two patients with urine cytology as the only positive finding had urothelial malignancy on further investigation. For the entire cohort the cost of cytology was £111,120.

Conclusions: routine urine cytology is costly and of limited clinical value as a first line investigation for all patients with hematuria, and should be omitted from guidelines.

Full text not available from this repository.

More information

Published date: April 2013
Additional Information: Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Keywords: Adult, Diagnostic Tests, Routine, Female, Hematuria, Humans, Male, Prospective Studies, Urine, Urologic Neoplasms, Journal Article

Identifiers

Local EPrints ID: 419090
URI: https://eprints.soton.ac.uk/id/eprint/419090
ISSN: 0022-5347
PURE UUID: e0348664-5f2c-41ea-b6b8-c6d81a8d4c61

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Date deposited: 29 Mar 2018 16:30
Last modified: 13 Mar 2019 18:44

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