Correlations between Routine Urinalysis and Cystoscopy
for the Diagnosis of Urinary Bladder Invasion in
Patients with Cervical Cancers
Tanan Bejrananda MD*, Worapon Ratanalert MD*, Jitti Hanprasertpong MD**, Surasak Sangkhathat MD***,
Watid Karnjanawanichkul MD*, Monthira Tanthanuch MD*, Choosak Pripatnanont MD*
Affiliation :
* Urology Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
** Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
*** Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Background : Cystoscopy is a study recommended in patients with cancer of cervix uteri (CC) to evaluate for urinary
bladder invasion (BI). However, yield of the study in early-stage CCs is very low, leading a search to find a less invasive
test that would help select patients with higher priority to undergo cystoscopy.
Objective : To determine clinical correlations between the screening urinalysis (UA) and cystoscopy for the diagnosis of
BI in patients with CC.
Material and Method: Medical records from the electronic database of CC patients treated in Songklanagarind Hospital
between 2004 and 2013 were reviewed. All newly diagnosed CCs were scheduled for a cystoscopy to evaluate for BI. Those
who had a UA sent within 100 days of cystoscopy were included. Data including patients’ age, stage at diagnosis, type of
treatment received, and UA profiles were analyzed for their correlations with the cystoscopic results.
Results : Eight hundred seventy five cases were included in the analysis. Mean duration from diagnosis of CC to cystoscopy
was 167 days. Cystoscopies were performed before treatment in only 238 cases (27.4%). The cystoscopic results reported
negative study in 791 cases (90.4%). Among the cases with positive findings, 23 cases (2.6%) had BI, while the majority
had chronic cystitis (6.7%). Tumor stages (III to IV), and time from diagnosis to do cystoscopy (those performed before
treatment initiation) were associated with higher BI positivity rates. The UA parameters that were significantly associated
with BI included proteinuria, bilirubinuria, nitrisuria, hematuria, and positive urine leukocytes. On multiple logistic
regressions, proteinuria, and nitrisuria were the two parameters independently associated with BI at the OR 6.49 (95% CI
1.81 to 23.22) and 3.77 (95% CI 1.17 to 12.07), respectively. When the two parameters were considered together with
the pre-cystoscopy status, the analysis showed that proteinuria and nitrisuria increased in the incidence of BI from 5% to
20 to 30% and 30% to 60 to 100% of stage III and IV cervical cancer, respectively.
Conclusion : Routine practice of cystoscopy in CC should be re-considered. As the yield is very low, the study might be
avoided in early stages. Priority should be given to those with stage III and IV, especially when protein and nitrite are
positive in the UA.
Keywords : Cervical cancer, Urinary bladder invasion, Urinalysis, Cystoscopy
All Articles
Download