Bladder washing cytology in the initial evaluation of patients with neuro-urological disorders: to do or not to do?

OBJECTIVES: To evaluate if bladder washing cytology (BWC) provides a diagnostic benefit in the initial evaluation of patients with neuro-urological disorders. PATIENTS AND METHODS: This prospective cross-sectional study investigated a consecutive series of patients with lower urinary tract symptoms referred for neuro-urological evaluation at our department of neuro-urology who underwent urethro-cystoscopy (UC) and BWC from 2018 to 2023. RESULTS: Among 581 neurological patients, 274 (47.2%) were females. Tumour-suspicious findings leading to surgical intervention were detected in 17 (2.9%) by UC alone and in three (0.5%) by BWC but unsuspicious UC, respectively. Overall, relevant histological findings after transurethral bladder surgery (TUBS) were detected in eight (1.4%, 95% confidence interval [CI] 0.6-2.7%) patients: keratinising squamous metaplasia (two) and non-muscle-invasive urothelial carcinoma (six), all were initially identified by UC. Three patients refused surgery, two of whom had positive BWC without suspicious lesion in UC. Sensitivity and specificity of BWC referenced to UC alone were 0% (95% CI 0.0-36.9%) and 99.7% (95% CI 98.7-99.9%), respectively. Adding BWC to UC increased costs by 22.8% without improving tumour detection. The main study limitation was the lack of true positives in BWC. CONCLUSIONS: Bladder washing cytology in addition to UC is not justified in the initial evaluation of patients with neuro-urological disorders as decision making regarding TUBS is based on UC findings. Moreover, omission of BWC saves relevant costs without compromising patient safety.