From the beginnings of medicine, the examination of urine has been regarded as valuable in the diagnosis of a wide variety of benign and malignant diseases. Urine could be placed on a glass slide and studied for cells, crystals, casts and other objects. This microscopic study, known as urine cytology, has been widely accepted as a front-line testing method for patients with a wide variety of urinary signs, symptoms or complaints. Some examples of symptoms which bring a patient to urologists include difficulty urinating, pain on urination, blood in the urine, abdominal pain or recurrent urinary tract infections. Patients with an increased risk of cancer of the urinary tract are often first tested using urine cytology.

Urothelial cells line portions of the kidneys, ureters, bladder and urethra. Typically, urothelial cells are found in small numbers in normal urine from healthy individuals. In disease processes such as infections, kidney or bladder stones or cancer of the urinary tract, there are increased numbers of many types of cells. If infection is present, bacteria, fungi or virally infected cells can be detected with the aid of urine cytology.

The most common type of urine specimen used for cytology interpretation is a randomly voided urine specimen. This is the easiest and most convenient type of sample for the patient to collect. The next most common type of urine specimen must be collected in the doctor’s office and is known as a catheterized urine. To obtain this specimen, a catheter or tube is placed in the opening of the bladder and the urine is collected as it drains directly out of the bladder. The urologist often performs a procedure known as cystoscopy in order to look directly into the bladder for abnormal areas or tumors. During the cystocopy procedure the urologist may take a small piece of tissue known as a biopsy specimen. Often the urologist will collect a specimen known as a bladder washing by vigorously washing the bladder using a sterile salt solution. This specimen is then sent to the laboratory for cytologic evaluation. Occasionally, it may be necessary to repeat this washing procedure in the areas of the kidneys which meet the ureters. These specimens are referred to as right or left renal washings. Urine specimens, washings and biopsy specimens are sent to a medical laboratory where experts known as pathologists examine the tissue and cells under a microscope. If further information is required or requested, modern tests often yield even further evidence of a bladder cancer. Some of these tests include ImmunoCyt™, FISH, p53, and DNA Ploidy. The experienced and specialized technologists and pathologists at Bostwick Laboratories® aid urologists in the diagnosis, treatment and management of patients with urinary tract disease.