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Introduction ⬇

Cells from the epithelial lining of the urinary tract exfoliate readily into the urine. Urine cytology is most useful in the diagnosis of cancer and inflammatory diseases of the bladder, the renal pelvis, the ureters, and the urethra. This study is also valuable in detecting cytomegalic inclusion disease and other viral diseases and in detecting bladder cancer in high-risk populations, such as workers exposed to aniline dyes, smokers, and patients previously treated for bladder cancer. A Pap stain of smears prepared from the urinary sediment, filter preparations, or cytocentrifuged smears is useful to identify abnormalities.

Procedure ⬆ ⬇

  1. Obtain a clean-voided urine specimen of at least 180 mL for an adult or 10 mL for a child.

  2. Obtain a catheterized specimen, if possible, if cancer is suspected.

  3. Deliver the specimen immediately to the cytology laboratory. Urine should be as fresh as possible when it is examined. If a delay is expected, an equal volume of 50% alcohol may be added as a preservative.

  4. Collect urine specimens or bladder washings in wide-mouthed containers; add 50% alcohol if laboratory transport will be delayed. Check with your laboratory for specific instructions.

  5. See Chapter 1 guidelines for intratest care.

Clinical Implications ⬆ ⬇

  1. Findings possibly indicative of inflammatory conditions of the lower urinary tract include:

    1. Epithelial hyperplasia

    2. Atypical cells

    3. Abundance of red blood cells

    4. Leukocytes

  2. Findings indicative of viral disease include the following:

    1. Cytomegalic inclusion disease—large intranuclear inclusions:

      1. Cytomegaloviruses or salivary gland viruses are related to the herpes varicella agents.

      2. Infected people may excrete virus in the urine or saliva for months.

      3. About 60%–90% of adults have experienced infection.

      4. In closed populations (e.g., institutionalized mentally disabled persons, household contacts), high infection rates may occur at an early age.

    2. Measles: Characteristic cytoplasmic inclusion bodies may be found in the urine before the appearance of Koplik spots.

  3. Findings possibly indicative of malacoplakia and granulomatous disease of the bladder or upper urinary tract include:

    1. Histiocytes with multiple granules in an abundant, foamy cytoplasm

    2. Michaelis–Gutmann bodies in malacoplakia

  4. Cytologic findings possibly indicative of malignancy. If the specimen shows evidence of any of the changes associated with malignancy, cancer of the bladder, renal pelvis, ureters, kidney, or urethra may be suspected. Metastatic tumor should be ruled out as well.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Patient preparation depends on the type of procedure being done. Explain the purpose, procedure, benefits, and risks to the patient.

  2. If cystoscopy is performed, administer anesthesia (general, spinal, or local). Refer to Chapter 12 for cystoscopy care.

  3. If voided urine is required, instruct the patient how to appropriately collect a clean-catch specimen.

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Clinical Alert

The only contraindication is an uncooperative patient

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. If cystoscopy is performed gently and with adequate lubrication, the patient should experience only minimal discomfort after the procedure.

  2. Be aware that aftereffects may include mild dysuria and transient hematuria, but these should disappear within 48 hours after the procedure. The patient should be able to void normally after a routine cystoscopic examination. Refer to Chapter 12 for cystoscopy care.

  3. Follow Chapter 1 guidelines for safe, effective, informed posttest care.

Reference Values ⬆

Normal

Negative

Epithelial and squamous cells are normally present in urine.

(See also Chapter 3, especially Microscopic Examination of Urine Sediment.)