Voided and washed urine cytology in diagnosis of bladder cancer. Dose it make differences?

Sami Mahjoub Taha, Tyseer Mohammed Omer, Mohammed AbdAlla Mohammadani, Mohammed El Imam Mohammed Ahmed, Moawia Mohammed Ali Elhassan, Khalid Eltahir Khalid


Objectives: To evaluate the diagnostic value of voided and washed urine cytology in diagnosis
of bladder cancer.
Methodology: This is a prospective, cross-sectional, descriptive hospital- based study conducted
at Gezira Hospital for Renal Diseases and Surgery (GHRDS). Random voided urine samples
from 86 patients with suspected bladder cancer were collected before cystoscopy and bladder
washing at the time of transurethral resection of bladder tumor (TURBT). Each urine and bladder
washing were examined microscopically, and the test is considered positive if cells are malignant
or suspicious.
Results: The study patients age ranged between 25- 95 years and 62 (72.1%) of the patients were
male with a ratio of 2.5:1. According to the histological finding: 90.3% of study cases were having
transitional cell carcinoma (TCC); 64.5% were having high grade urothelial cancers (2 or 3), and
Khartoum Medical Journal (2017) Vol. 10, No. 03, pp. 1411 - 1418
Urine cytology was popularized by George
Papanicolaou in the 1940s as a way to detect
and follow-up patients with bladder cancer
(BC) (1). The current standard of care for the
primary detection and follow-up of nonmuscle-
invasive bladder cancer (NMIBC)
consists of urethro-cystoscopy (UCS), which is
invasive and uncomfortable.
Cytopathological examination of urine is a
routine, non-invasive, diagnostic procedure
to detect cancers of the urinary tract. Many
urine-based tests have been developed, and in
general, these tests have a higher sensitivity than
cytology, but a lower specificity. Furthermore,
urine cytology enables direct microscopic
examination of individual urothelial cells and it
has shown clinical cost-efficacy when compared
with novel tests such as: bladder tumor antigen
(BTA), nuclear matrix protein 22 (NMP22) and
fluorescence in-situ hybridization (FISH) (2).
The accuracy of urine cytology depends on
several factors that are mainly related to:
histologic grade of the tumor, the pre-treatment
or post-treatment status, the nature of specimen
and sampling (3). There are six types of urinary
specimens for cytologic analysis, the most
common is voided urine. Bladder washing
samples are also very frequent samples sent for
cyto-pathological examination.
A most common sample from the urinary tract
is spontaneous-voided urine. In collecting true
voided urine, one should avoid the first morning
41.9 were diagnosed as having bladder tumor grade 3. The sensitivity of both voided and washed
urine cytology in the study was 93.5%; specificity 100%; and positive predictive value was 100%.
More than79% of bladder wash-out specimens had an excellent quality with more cellularity and
preservation of cells observed in cytological smears, while only 30.2% of voided urine had an
excellent quality.
Conclusion: We have demonstrated the superiority of bladder washing over voided urine cytology
in terms of excellent quality with more cellularity and preservation of cells in the cytological
smears, and recommend its routine use in spite of patient discomfort and the additional cost.

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ISSN: 1858-5345