Routine Urine Cytology Has no Role in Hematuria Investigations

PURPOSE: Urine Cytology has been a longstanding first line investigation for haematuria and is recommended in current major guidelines. Objectives are to determine the contribution of urine cytology in haematuria investigations and its cost implications MATERIALS AND METHODS: Data prospectively collected for 2778 consecutive patients investigated for haematuria at a UK teaching hospital January 1999 to September 2007 with final analysis in October 2010. All patients underwent standard haematuria investigations; urine cytology, flexible cystoscopy and renal tract US with IVU or CTU performed for visible haematuria patients without diagnosis following first line tests. Patients with positive urine cytology as the only finding underwent further cystoscopy, retrograde studies or ureteroscopy with biopsy under general anaesthetic. Outcome in terms of eventual diagnosis were cross-referenced with initial urine cytology results (classified as malignant, suspicious, atypical, benign or unsatisfactory). Cost of urine cytology was calculated. RESULTS: 124 (4·5%) patients had malignant cells and 260 (9·4%) atypical/ suspicious. 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, cost for cytology was £111,120. CONCLUSIONS: Routine urine cytology is costly and of very limited clinical value as a first line investigation for all patients with haematuria and should be omitted from guidelines.