Urinary Tract Discomfort

[bj]

I am a 36 year old female.  In May 1998, I had intense pain as described by that of kidney stones.  After a 4 hr stay at the emergency room, I was found to have blood in the urine which the doctor contributed  most likely to kidney stones.  Before leaving the hospital the pain had subsided.  All the symptons I had prior to the onset of the pain were also gone (i.e. burning sensation, frequency in urinating, cloudy urine).  In May 1999, I experienced the same intense pain for about 16 hrs.  This time I also experienced nauseau and vomiting.  A UA again showed traces of blood in the urine. Upon going to bed, I was in intense pain.  The next morning, I felt fine.  The urine was not strained either time, so a kidney stone was never physically seen.
  
I am once again experiencing symptons associated with a bladder infection except I don't have any pus\bacteria in my urine.  A UA detects a small trace of blood. The amount of protein and sugar level is normal.  These symptons began in September.  Although the urge to go to the restroom has decreased,  I still experience a burning sensation and my urine is cloudy. I had an IVP done in November which came back negative for kidney stones and everything else functioning properly.  In December, I saw a urologist who did a pelvic and UA.  The UA once again showed a trace of blood in the urine.  Knowing by previous history, he pointed out a couple of areas on the x-ray that could possibly be kidney stones, one located in my bladder and the other in the urethea as it enters my bladder.  He also stated that if I wasn't experiencing the bladder infection like symptons and only had the trace of blood in my urine with the negative IVP, he would recommend sending me home without any further testing.  His recommendation was exploratory surgery.  
Can you give me any information on bladder urine cytology(i.e. the procedure as well as the cost).

[HFHS M.D.-BL]

Dear BJ,

Urine cytology is often used when there is a suspicion of bladder cancer.  There is a complex pathologic criteria for the identification of malignant cells in cytology samples based on the appearance of the cells in the urine under the microscope.  Cytologic examination of the urine is highly accurate (95%) in the diagnosis of high-grade cancer and carcinoma in situ, but it is less helpful (10-50% accurate) in diagnosing low-grade bladder cancer.  Cytologic examinations are often helpful when a bladder mucosal abnormality is suspected even though a cystoscope exam (looking inside your bladder with a lighted tube) was normal.  This is a relatively inexpensive laboratory test, however, the actual charge will vary between hospitals.


Even though no stones were present on your IVP, you continue to have microscopic hematuria and this deserves a complete work up.  Microscopic hematuria is defined as blood in the urine that is only evident under the microscope.  No blood is discernible by the naked eye.  The complete work up for microscopic hematuria includes a complete history and physical, IVP, and a cystoscopy.  After these tests have been completed a diagnosis will be apparent in 75% of cases.  The other 25% will require further testing, but still in 5-10% of cases no definite cause can be found.  The most common causes of hematuria in a person in your age group (20-40y/o) are acute urinary tract infection, stones, and bladder tumor.  The key element missing from your work up is a cystoscopy.  Urine cytology is not a replacement for cystoscopy.


This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).


Sincerely,
HFHS M.D.-BL
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