More Than Just Pee in a Cup: Urine Cytology

What Is Urine Cytology?

Cytology is the examination of cells from the body under a microscope. In a urine cytology exam, a doctor looks at cells collected from a urine specimen, to see how they look and function. The test commonly checks for infection, inflammatory disease of the urinary tract, cancer, or precancerous conditions.

It’s important to note that this test doesn’t identify cancer, nor can it completely rule out cancer. Urine cytology is better at finding larger and more aggressive cancers than small, slow growing cancers.

This procedure is different from a biopsy in that it examines individual cells, rather than pieces of tissue containing many cell clusters. The cells for urine cytology are easier to obtain than tissue, causing less discomfort and less risk to the patient. Sometimes a biopsy is necessary after abnormal results from urine cytology to clarify the diagnosis.

Why Do I Need Urine Cytology?

Your doctor may order a urine cytology exam if you have any of these symptoms:

  • unexplained blood in your urine
  • burning during urination
  • persistent pain during urination

The test also monitors patients who have had urinary tract infections or cancer or who are at high risk for bladder cancer. It can also detect a variety of viral diseases.

What Is the Procedure for Urine Cytology?

There are two ways to obtain the cells needed for a cytology exam. Your doctor can collect a sample during a cystoscopy, which is an examination of the inside of the bladder, or you can provide a clean catch urine sample.


A cystoscopy is performed using a cystoscope, a thin tube with a small camera on the end. The procedure takes between 10 and 20 minutes.

Because the urine from your first morning urination remains in your bladder for many hours through the night, the cells may degrade and not be useful for urine cytology. However, this doesn’t mean you should urinate right before the test. In fact, you may need to hold urine in your bladder for a few hours prior to a cystoscopy. Be sure to ask your doctor for specific instructions before the test.

For a cystoscopy, your doctor will clean the skin around your urethra (tube coming out from the bladder) and use a topical gel to numb the area. They will insert the cystoscope into your urethra and up into your bladder. You may feel some pressure and an urge to urinate. Your doctor will drain your urine into a sterile container, and then remove the catheter.

The procedure carries a small risk of infection or bleeding. Your doctor will send the urine sample to a laboratory for analysis, and then will receive a report.

Clean Catch Urine Sample

A clean catch urine sample is easy, noninvasive, and carries no risk. Otherwise known as a midstream urine sample, you can do a clean catch urine sample in a doctor’s office or in the comfort of your own home.

Your doctor’s office will provide a special container to collect the sample. Be sure to ask your doctor for specific instructions regarding the proper way to get the sample and where to bring it when you finish. Failure to follow instructions may provide a poor result, and you may have to repeat the test.

You will use special cleansing cloths to clean the skin around your urethra prior to the test. You will need to urinate a small amount into the toilet, and then stop the flow of urine. Then you will urinate into the sterile container until reaching the desired level. You may then finish urinating into the toilet.

In some cases, your doctor may want you to provide urine samples over the course of several days. Your doctor will send the urine sample to a laboratory for analysis, and then will receive a report.

What Happens in the Laboratory? | Lab Tests

A pathologist will analyze the cells under a microscope to see if there are any abnormalities. They may also look at the cells in a culture dish to see if bacteria or other organisms are growing.

The pathologist will send the results of your urine cytology test to your doctor, who will report the results to you. Ask your doctor how long you can expect to wait for your results.

What Do the Test Results Mean?

Different laboratories use different language in their reports. Your doctor will be able to explain what your results mean. There are some common terms that can describe your results.


If your urine cells appear normal and are free of bacteria and yeast, this is a normal result. Most labs will call this a “negative” result.


The lab may label your specimen “unsatisfactory” if there weren’t enough usable cells in the sample. In this case, you will likely have to repeat the procedure and provide a new sample.

Atypical or Suspicious

These terms describe when cells don’t appear normal, but it can’t be confirmed that they are cancerous or precancerous.


If bacteria or yeast are present in the culture, you probably have a bladder or urinary tract infection. Antibiotics can usually treat these conditions.

Cells that appear abnormal in your urine may also indicate inflammation in the urinary tract or cancer of the bladder, kidney, ureter, or urethra. However, an abnormal urine cytology result can’t diagnose these diseases. Additional tests are usually necessary to confirm the diagnosis.

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