Choosing Wisely:

Don’t perform urine cytology for routine hematuria investigation.

Rationale and Comments: Urine cytology has little value in the diagnosis of common causes of hematuria. Routine urine cytology is costly and of limited clinical value as a first-line investigation for all patients with hematuria. Because this test has low sensitivity for diagnosing low-grade superficial urothelial malignancy, a negative test does not rule out malignancy. Although urine cytology has reasonable specificity when positive, it is impossible to localize a tumor based on urine cytology alone. A positive test would require further invasive investigation including upper urinary tract imaging and flexible cystoscopy.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Urologic
  • References: • Mishriki SF, Aboumarzouk O, Vint R, et al. Routine urine cytology has no role in hematuria investigations. J Urol. 2013;189(4):1255-1258.
    • Viswanath S, Zelhof B, Ho E, et al. Is routine urine cytology useful in the haematuria clinic? Ann R Coll Surg Engl. 2008;90(2):153-155.

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