To highlight the impact of cytopathology on patient management and treatment Edited by Martha B. Pitman, MD
Clinician’s Corner The Value of Urine Cytology in the Workup of Hematuria Wassim Kassouf, MD, CM, FRCSC, Associate Professor, Department of Urology, McGill University Health Center Dr. Wassim Kassouf completed a fellowship in urologic oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas, before joining the McGill University Health Center in 2006. Dr. Kassouf’s clinical practice focuses on all aspects of urologic oncology, whereas his research focuses on bladder cancer. He is the Program Director of the McGill Urology Residency and a member of the Royal College Urology Specialty committee. He has led several national guidelines for optimizing quality of care in urologic cancer management and has published over 245 peer-review articles. He is a cofounder of Bladder Cancer Canada, cochair of the National Cancer Institute of Canada’s disease-oriented group in bladder cancer, Vice-President (communications) of the Canadian Urological Association, and an executive member of the National Institutes of Health Genitourinary steering committee Bladder Cancer Task Force.
One common referral to urology continues to be an evaluation of a patient with hematuria. Hematuria either can be nonvisible and identified on urine microscopy (microscopic hematuria) or can be visible (gross hematuria). Furthermore, patients can be asymptomatic or can have lower urinary tract symptoms (urgency, frequency, and dysuria) associated with hematuria. Significant microscopic hematuria is defined as >2 erythrocytes per high-power field present on 2 microscopic urinalyses in the absence of urinary infection, recent exercise, menses, sexual activity, or instrumentation.1,2 A urinary dipstick test is a good positive predictor (sensitivity, 91%-100%) but cannot be used to rule in hematuria, because there are many potential reasons for false-positives (eg, myoglobinuria and oxidizing contaminants) and false-negatives (eg, presence of reducing agents like ascorbic acid, urinary pH
Clinician’s Corner The Value of Urine Cytology in the Workup of Hematuria Wassim Kassouf, MD, CM, FRCSC, Associate Professor, Department of Urology, McGill University Health Center Dr. Wassim Kassouf completed a fellowship in urologic oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas, before joining the McGill University Health Center in 2006. Dr. Kassouf’s clinical practice focuses on all aspects of urologic oncology, whereas his research focuses on bladder cancer. He is the Program Director of the McGill Urology Residency and a member of the Royal College Urology Specialty committee. He has led several national guidelines for optimizing quality of care in urologic cancer management and has published over 245 peer-review articles. He is a cofounder of Bladder Cancer Canada, cochair of the National Cancer Institute of Canada’s disease-oriented group in bladder cancer, Vice-President (communications) of the Canadian Urological Association, and an executive member of the National Institutes of Health Genitourinary steering committee Bladder Cancer Task Force.
One common referral to urology continues to be an evaluation of a patient with hematuria. Hematuria either can be nonvisible and identified on urine microscopy (microscopic hematuria) or can be visible (gross hematuria). Furthermore, patients can be asymptomatic or can have lower urinary tract symptoms (urgency, frequency, and dysuria) associated with hematuria. Significant microscopic hematuria is defined as >2 erythrocytes per high-power field present on 2 microscopic urinalyses in the absence of urinary infection, recent exercise, menses, sexual activity, or instrumentation.1,2 A urinary dipstick test is a good positive predictor (sensitivity, 91%-100%) but cannot be used to rule in hematuria, because there are many potential reasons for false-positives (eg, myoglobinuria and oxidizing contaminants) and false-negatives (eg, presence of reducing agents like ascorbic acid, urinary pH
