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.