Clinically unconfirmed positive urinary cytology: diagnostic implications and oncological outcomes.

OBJECTIVE: •To evaluate the natural history of patients presenting with positive urinary cytology in the absence of clinically identifiable disease.

PATIENTS AND METHODS: •A surgical database was queried to identify 48 patients with positive urinary cytology of undetermined source. •All patients underwent a thorough urological evaluation consisting of random bladder biopsies, lateral montanal prostate biopsies, bilateral retrograde pyelography and selective urine cytology sampling from each ureter. •Time from presentation to definitive diagnosis was estimated using the Kaplan-Meier method.

RESULTS: •In total, 27 patients (56%) had a history of bladder cancer and 21 (44%) were evaluated for irritative voiding symptoms or haematuria. •At a median follow-up of 31 months, the source of the positive cytology was identified in 32 patients (67%): in 29 (61%) as bladder cancer, in two patients (4%) as upper tract tumour and in one patient (2%) as transitional cell carcinoma of the prostate; 29/32 (91%) had high-grade disease and the predominant clinical stage (53%) was carcinoma in situ. •The median (interquartile range) interval from presentation to diagnosis was 19 (8-22) months, and was significantly shorter in naive patients than in those with a previous history of bladder cancer (13 vs 27 months, P < 0.05). •Disease-free survival with an intact bladder at 4 years was 74% (95% CI, 63-85).

CONCLUSIONS: •Unconfirmed positive urine cytology often predates the development of high-grade urothelial carcinoma. •The bladder is most commonly involved. •The time to diagnosis is generally protracted, although the long0term outcome appears to be favourable.