[The value of urine sediment cytomorphology in the ambulatory differential diagnosis of hematuria].

In order to improve early diagnosis of urotheliale neoplasms (UN) in nephrology outpatient clinic, 274 patients (221 male and 53 female, mean age 54 yrs), with recurrent hematuria (> 5 E/hpf) were investigated in years 1994-1998. The following examinations of fresh urine sediment were performed: in 114pts (group 1) erythrocytes of urine sediment examined with phase-contrast microscopy (PCM); in 129pts (group II) urine sediment examined with classical oncological cytology; in the III-rd group of 31pts (29M and 2F, aged 61-72), both methods were used because of high suspicion on UN on the ground of initial result of PCM, precisely clinical anamnesis as well as predominance of men in advanced age. Results were as follows. In the I-st group, in 6 from 42pts with urological hematuria in PCM, what means 5.2% of the whole group and 14% of the subgroup with urological hematuria, in further standard urological examination bladder carcinoma was found. In the II-nd group, positive result of urinary cytology (GI to GIII) was found in 7pts, what means 5.4% of the whole group. Results of urine cytology were confirmed later in the standard urological examination, which detected bladder carcinoma in all these patients. In the III-rd group, bladder carcinoma was found in all 22pts with urological hematuria in PCM. In 19 patients from this subgroup, urinary cytology was positive for UN (GI to GIII). In the remaining 3pts results of urinary cytology were false negative. False positive result of urinary cytology occurred in one from 9pts with glomerular hematuria and clinical or morphological (in renal biopsy) evidence of glomerulonephritis. On the results of the study, we propose--as an obligatory--in every case of recurrent hematuria of urological origin in PCM, examination of fresh urinary sediment with classical oncological cytology, especially if the patient belongs to the high risk group for urotheliale neoplasms.