Usefulness of Urine Cytology as a Routine Work-up in the Detection of Recurrence in Patients With Prior Non-Muscle-Invasive Bladder Cancer: Practicality and Cost-Effectiveness

PURPOSE: To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. MATERIALS AND METHODS: We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected. RESULTS: Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). CONCLUSIONS: Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.

Economical choices in setting up a diagnostic myeloma laboratory.

In setting up a diagnostic myeloma laboratory the popular, highly automated and otherwise excellent choices of equipment and laboratory practices, so exorbitantly raise costs that the sustainability, even in large government hospitals in third world countries may become difficult. Based on our experience in a regional cancer center in India, we offer here, guidelines for carrying out high resolution electrophoresis, densitometry, immunofixation and urine concentration. We show that by simply employing well established techniques and doing them properly, one can get results of excellent quality at minimum cost and minimum dependence on costly imports.

A cheap and convenient modification of arsine generator used for arsenic estimation.

In a study observing the effect of spirulina in the treatment of chronic arsenic poisoning quantitative estimation of arsenic in the urine of the patients was necessary. It was decided to try a modification of the arsine generator in the process. An alternative apparatus was designed following the structure of arsine generator by White (1976) using a 50-ml conical flask with rubber cork, 4-ml injection vial, two 3" long glass tubes and a glass test tube. An experiment was carried out with solutions containing known amounts of arsenic. The alternative arsine generator was tried in the estimation of arsenic content in those solutions. The results revealed that the apparatus permitted correct measurement of arsenic concentration. The alternative arsine generator was cheap easy to use and provided authentic results in estimation of arsenic concentration in the urine of patients with chronic arsenic poisoning.

Qual o valor da sedimentoscopia em urinas com características físico-químicas normais? / Is it worth-while doing urine sediment microscopy in dipstick physiocochemical normal samples?

O valor da sedimentoscopia em amostras de urina com exame físico-químico normal é questionado na literatura médica estrangeira, sendo que muitos pesquisadores a julgam desnecessária. Procurando contribuir para a elucidação desta dúvida e levando-se em conta que a maioria dos laboratórios brasileiros sempre executa o exame completo, foi analisada uma amostragem de uma clientela essencialmente ambulatorial, cujas requisições não permitiam determinar se havia finalidade diagnóstica. Fez-se um estudo de 10.234 amostras, que foram submetidas ao exame de rotina, sendo que 5.000 apresentaram exames físico-químicos normais. Destas foi feita uma avaliação dos achados da microscopia do sedimento que pudessem ser considerados possivelmente relevantes clinicamente. Entre esses achados, os de maior incidência foram: cilindros (29 exames - 0,58 por cento) e piócitos em número igual ou superior a cinco por campo (26 exames - 0,52 por cento). Todos os demais parâmetros foram encontrados em números iguais ou inferiores a 0,4 por cento. Um percentual de 98,02 por cento destas amostras não revelou anormalidade à microscopia. A análise estatística pelo método do X² (p < 0,01) sugere que não há necessidade da execução da sedimentoscopia nas urinas sem anormalidades no exame físico-químico, o que representaria uma redução de 48,85 por cento dos sedimentos examinados. Desta forma se obteria uma sensível economia de tempo e de gastos, sem nenhum prejuízo para o paciente

Imagecytometry: a new tool for diagnosis of glomerular haematuria.

Differentiation between glomerular and nonglomerular haematuria is a major challenge in clinical medicine, which is very important for a definitive diagnosis and management in individual cases. Phase contrast microscopy of red cells in urine is the standard practice for diagnosis of glomerular haematuria. Urine cell flowcytometry is recently being used for such diagnosis. In this context, the role of determination of haemoglobin content of urine red cells is not know. Application of image analysis to study the red cells in urine may be more objective and accurate for the diagnosis. The present study has been undertaken to evaluate the urine red cells with the help of an automated computerized image analysis system for determination of hemoglobin content by integrated optical density (IOD). The morphometric parameters were also analyzed. The glomerular RBCs were significantly smaller in diameter, area and perimeter than nonglomerular RBCs with a greater variation in shape and lower [OD (p<0.0001 to <0.00002). With the help of morphometric parameters the percentage of cases diagnosed correctly varied from 90 to 95. The IOD helped to diagnose 100% cases. Thus application of this new technique may be very useful diagnostic tool in the investigation of haematuria.