This document discusses cytology of the urinary tract. It describes three methods for collecting urine specimens: voided urine, catheter specimens, and bladder washings. Voided urine is the simplest but cells may degrade over time. Catheter specimens avoid contamination but can damage cells. Bladder washings provide high cellularity and preservation through saline irrigation. Specimens can be prepared via several methods including cytocentrifugation and direct smears. Normal urinary tract cytology shows a range of superficial and deep urothelial cell morphologies depending on collection method and location in the tract.

1. CYTOLOGY
OF URINARY
TRACT
PRESENTED BY,
S.SHRUTHI VASAN
III BSC.CLT
DR.NGPARTS & SCIENCE
COLLEGE
COIMBATORE

2. SPECIMEN COLLECTION
Three types of sample can be collected:
• Voided urine
• Catheter specimen
• Bladder washings

3. VOIDED URINE
Simplest method of collection.
Early morning urine should be avoided because of the poor
morphological details shown by the cells exfoliated during
the night and being exposed to urine for several hours.
The best is a mid-morning specimen.
The sample should be sent to the laboratory as soon as
possible.
If a short delay is inevitable the container should be kept in
a refrigerator.
In case of longer delay some alcohol should be added to
the sample.

4. CATHETER SPECIMENS
This method facilitates the collection of good samples without
contamination.
The method of choice when urine must be collected from one
of ureters.
The disadvantages are that it is an invasive procedure with the
possibility of detaching sheets of urothelial cells with the tip
of the catheter.
These cells can mimic cells from a papillary tumour
cytologically.

5. BLADDER WASHINGS
This is also known as barbotage.
It is performed by irrigating the bladder with a saline
or fixative solution.
 It has the same disadvantages of catheter specimens,
but the cellularity obtained and the cell preservation
are very good and superior to voided urine.

6. PREPARATION OF SPECIMEN
• Eposti’s fixative
• Cytocentrifugation
• Direct smear
• Membrane filter preparations
• Monolayer preparations

7. ESPOSITO'S FIXATIVE
Good fixative fluid for bladder washing .
100 ml of Esposito's fixative contains 10 ml of acetic acid,
45 ml of methanol and 45 ml of deionizer water.
The fluid is used to irrigate the bladder, collected in a 250
ml bottle and then sent to the laboratory.
It is centrifuged to obtain a pellet, the supernatant discarded
and 2 drops of pectin added to the pellet to facilitate
detachment from the centrifuge tube wall.
Finally two drops from the cell pellet are placed on a
microscope slide, air-dried at room temperature and stained
according to the Papanicolaou method.
Two or more slides are prepared for each case.

8. OTHER PREPARATION
TECHNIQUES
• Centrifugation followed by Cytocentrifugation.
– Alcohol fixation is necessary before staining with the
Papanicolaou method.
– Cytocentrifugation should produce a sample which is almost a
monolayer of cells measuring about 6 mm in diameter.
• Direct smears
– They are easier to prepare but show usually scanty cellularity.

9. • Membrane filter preparations:
– They show very good cellularity, but are difficult to
prepare.
– Preparations are fixed in alcohol and stained using the
Papanicolaou stain.
• Monolayer preparations such as Thin Prep
– Preservation of the cells - very good
– Procedure is easier than the filter method.
– Expensive

10. Urinary Tract Histology
Superficial cell layer :
• one cell thick, superficial squames-size or larger,
multinucleated
Intermediate cell layer :
• approximately 5 cell layers, parabasal-size cells
Basal cell layer :
• one cell thick, cuboidal-columnar

11. URINE BLADDER

12. UPPER URINARY TRACT
HISTOLOGY
URETER AND
RENAL PELVIS
• Lining cells are
larger and more
pleomorphic than
bladder (decreased
cell turnover &
exfoliation).

13. NORMAL URINARY TRACT
CYTOLOGY
SUPERFICIAL UROTHELIAL CELLS
• Marked variation in size and
shape (10-150 u), low N/C
• Often polygonal
• Abundant pale cytoplasm,
well defined borders
• Occasional vacuolization
• Round-oval nuclei, often
multinucleated

14. NORMAL URINARY TRACT
CYTOLOGY
DEEP UROTHELIAL CELLS
• Uniform in shape and
size (10-20 u)
• Scant to moderate
dense cytoplasm,
distinct borders, fine
vacuolization
• Central nuclei, finely
granular chromatin,
small nucleoli

15. Voided Urine Is Sparsely Cellular, Single
Cells-degeneration

16. Catheterization or washings specimens
have many clusters