The value of upper tract cytology after transurethral resection of bladdertumor in patients with bladder transitional cell cancer

Purpose: Patients with transitional cell carcinoma of the bladder are at ri sk for concurrent or subsequent cancer of the upper tract. Traditionally di sease is monitored by radiography (excretory or retrograde urography). Some elect to sample the upper tract by obtaining urine for cytology. Are the r esults meaningful when performed in a patient with bladder cancer? Materials and Methods: We evaluated 27 consecutive patients with transition al cell cancer of the bladder (grade I to 3, Ta to T2) with bladder wash fo r cytology and cystoscopy as well as resection of visible tumor. A 5F urete ral catheter was positioned at each ureteral orifice, flushed with saline a nd passed into each renal pelvis. Urine was collected for cytology. Results: Of 19 patients (68%) with high grade (grade 3) bladder cancer 13 h ad a positive bladder wash, including 6 (32%) with tumor cells detected in the urine from the upper tract. Of 8 patients (38%) with low grade (grade 1 to 2) transitional cell cancer 3 had a positive bladder wash and 2 (25%) h ad a positive upper tract cytology. All patients had a normal upper tract b y excretory or retrograde urography. Ureteroscopy was not performed. Conclusions: Given the normal appearance of the upper urinary tract, it is highly unlikely that most, if any, of these patients with bladder cancer ha ve tumor in the upper tract despite tumor cells in urine obtained by retrog rade catheterization, Thus, upper tract sampling by a retrograde technique lacks specificity for localizing transitional cell cancer to the upper trac t when performed in a patient with bladder cancer.