Urine Collection in Cytology

8/13/2019 Urine Collection in Cytology

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URINE CYTOLOGY

Urine cytology is an examination of the urine undera 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.


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Urine cytology test may recommend if any of thesesymptoms appear: Blood in urine (hematuria).

Burning during urination.

Pain during urination.

Female Urinary System Male Urinary System


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Each laboratory has its own way of describing the resultsof a urine cytology exam.

Some common words used in pathology reports include:Results Descriptions

Unsatisfactory

specimen

Not enough cells or the wrong types of cells were found in

urine sample.

May need to repeat the urine cytology test

Negative No cancer cells were identified in urine sample.

Atypical Some abnormalities were found in the cells in urine

sample.

But they were not abnormal enough to be consideredcancer.

Suspicious Urine cells were abnormal and may be cancerous.

Positive Cancer cells were found in urine sample.


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A urine cytology test cannot be used alone to diagnosecancer.

If atypical or cancerous cells are detected, a cystoscopy

procedure or computerized tomography (CT)scan maybe recommend to examine the bladder and urinary tractfor abnormalities.

Female Cystoscopy Male Cystoscopy


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URINE COLLECTION FOR CYTOLOGY

Urine cytology is useful in diagnosing diseases thatinvolve the mucosal surface.

Knowing the type of exfoliated urinary tract specimen isessential.

Therefore, clinical information should include whether

the specimen is voided, catheterizationor a bladderwashing.

The clean-catch voided urine is recommended forscreening purpose.

But if suspecting bladder malignancy, bladder washing ispreferred.

It is important that no alcohol or any other preservativesare added to the specimen.

Fresh is the most desirable specimen.


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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 heldovernight in the bladder may be degraded and cannot be used for urinecytology.

In women, voided urine may be contaminated by vaginal cells but inmost cases this does not affect a diagnosis.

Thus, a midstream (clean-catch) specimenis recommended to ensure the adequacyof the sample.

The clean-catch urine method is used toprevent germs from the penis or vagina

from getting into a urine sample. The minimum amount of urine necessary

to ensure adequate cellularity may be ashigh as 25-100ml.

A special clean-catch urine kit thatcontains sterile wipes may be given.


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Voided Urine

Female Patients Male Patients

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

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.

Clean the urethral opening

(head) of the penis with a

sterile wipe.

If uncircumcised, retracting

the foreskin, carefully wipefrom front to back with a

sterile wipe.

Use a sterile wipe only once

and discard.

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.


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Catheterized Urine Specimen obtained by

catheterization have

disadvantages: Catheterization cainfectionrries a

risk of urinary tract.

Urine collected from anindwelling catheter is often apooled specimen that has beenat room temperature for manyhours and cellular degenerationcan be occurred.

The tip of the catheter oftenscrapes off benign urothelial cell

clusters which mimic theappearance of a papillaryneoplasm.

The urinary catheterizationprocedure should be carried outby a nurse or doctor.


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Catheterized Urine

Female Patients Male Patients

Clean the urethral areacarefully.

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

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.


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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 advantagesof bladderwashing over voided urine are:

Better cellular preservation. Greater cellularity.

Less chance of contamination bybackground debris.

Place specimen in clean

container and bring tolaboratory immediately.

If unable to bring immediately,place in refrigerator until it isbrought to the laboratory.


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Specimen

Types

Advantages Disadvantages

Voided urine Non-invasive

No instrumentation

artifact

Low cellularity

Vaginal contamination

Poor preservation

Cathetherized High cellularity Invasive

Instrumentation artifact

Poor preservation

Bladder washing

High cellularity Good cell

preservation

Invasive Instrumentation artifact

Relative Advantages and Disadvantages of UrineSpecimen Types


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References

Urine Cytology. (2011). Mayo Clinic. RetrievedNovember 16, 2013 fromhttp://www.mayoclinic.com/health/urine-cytology/MY00948

Urine Collection for Cytology. (2003). Pocono HealthSystem. Retrieved November 16, 2013 fromhttp://www.pmclab.org/manual/7CytologySpecimenCollection_2a.pdf

Urinary Tract Cytology. (2013). Cytology Stuff.Retrieved November 16, 2013 fromhttp://www.cytologystuff.com/study/nongynintro3.htm

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Urine Collection in Cytology