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Ann R Coll Surg Engl 2008; 90: 153-155 153The value of urine cytology in the investigation of haematuria is debatable. 1,2As a small minority of cases of transitional cell carcinoma may only be detected by urine cytology, it has been suggested that one can justify the cost of performing routine cytology on all new patients with haematuria. 3The American Urological Association (AUA) best-practice policy for urine cytology recommends the test only in patients with risk factors for transitional cell carcinoma. 4 Urine cytology may be a useful adjunct in the diagnosis of urothelial carcinoma. Overall sensitivity is, however, dependent on the degree of differentiation. Interpretation of cytology is observer-dependent and lacks a simple reproducible consensus for diagnostic criteria and terminology. Interpretation may be compromised by atypia, low cellular yield, inflammation, degenerative changes and therapeutic interventions. A fresh, uncontaminated specimen is required in order to optimise evaluation.Performing urine cytology on all patients has significant financial and man-power implications. This study evaluates the clinical value and cost-effectiveness of urine cytology in a one-stop haematuria clinic. Patients and MethodsA total of 1000 consecutive patients who attended the onestop haematuria clinic, with either microscopic or macroscopic haematuria, between June 2003 and November 2004 were studied prospectively. The patients were evaluated according to a standard protocol. All patients were seen and examined by a member of the urology team and investigated on the same day. Investigations included urine cytology, blood tests as appropriate, upper tract imaging (IVU for macroscopic haematuria or ultrasound scan for microscopic haematuria) and flexible cystoscopy.Urine samples were obtained at the time of examination before flexible cystoscopy and prepared according to a standard protocol. All abnormal results including malignant cells, suspicious cells and atypical cells were considered positive. The objective of this study was to determine the value of routine urine cytology in the initial evaluation of patients presenting to a one-stop haematuria clinic. Ann R Coll Surg Engl

Our study suggests that the pain experienced with the non-anaesthetic gel is no greater than that experienced with the anaesthetic gel. The non-anaesthetic gel is as effective as the anaesthetic gel and its regular use should be advocated in routine practice.

We report an unusual but catastrophic complication of 'haemo peritoneum' noted following an uneventual insertion of ureteric stent. Its management was primarily affected by the presence of a significant coexisting pathology. This case highlights two important points: (1) recognizing the most rare but real possibility of major intra peritoneal haemorrhage following simple stenting of the ureter (2) the importance of checking that the guide wire has been correctly preloaded in the spool before its placement up the ureter as inserting the wrong (nonfloppy) end may have serious implications.

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