Atypical cells in the urine

A week ago I had my fourth clear cystoscopy. Urine cytology showed atypical cells. The urine sample was taken 48 hours after the cystoscopy. In my opinion the reason for atypical cells among others might be because urine cytology was not taken before the cystoscopy and the urethra end the bladder can be affected by cystoscopy for several days .
Any thoughts or experience?

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Instrumentation is definitely a cause for abnormal cytology results. Most often this mimics low grade papillary lesions, if any comment as to type of abnormality was made. It would be more uncommon for this to be a confusion with a high grade lesion, but I suppose that too could be a problem. One of the systems for reporting urine cytology is negative for malignancy, atypical, suspicious for malignancy and positive for malignancy. Using this system atypical means a slight, but significant deviation from normal. Things that cause groups of urothelial cells to be scraped off may result in abnormal results up to thinking it is a low grade papillary tumor. Among these are cystoscopy, catheterization, bladder washes, stones, some infections. A good plan might be a follow up urine in a month or so, if you are concerned.


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An experienced pathologist might be able to say if the atypia is because of inflammation or malignancy; If the bladder is clear it will be advisable to do another cytology after 3-4 weeks. If you still see atypical cells then it will be advisable to evaluate the upper track.

I too had atypical cells about a couple of years back and it turned out to be inflammation. (but I had to go through the complete workup of the upper track)

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Four months ago, I had a cysto that ended up with a biopsy and removal of a suspicious spot which turned out to be a reaction to mitomycin, anyway, 2 days later, the lab results came back with atypical cells, my uro told me not to worry and they would keep a close eye on the situation, these more often than not can be caused by instruments during procedures, two weeks ago I had another cysto and bilateral kidney retrograde in the hospital under general anesthesia, this time, I got an all clear and no atypical cells. Just make sure these are monitored, in most cases, they turn out to be nothing.

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Well, welcome to my world. I had bladder cancer in 2007. I have been cancerfree since then in my bladder. During this time, I consistantly had atypical cells in my urine. However, they kept a watch on me. I just had 5 biopsies in my bladder and they are still cancer free. However, I had a retrograde pyelogram and instead of atypical cells, maliganancy was found. At this point they will check me every three months. They will have a close watch on me. I am thrilled that my bladder is clear. I really don't want to lose my bladder. I may need to lose a kidney, but that I can do. I know many people that do well with only one kidney. I have had a tough ride for over 7 years, but I can do it. So, can you !!! xxoo Buddygramma

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I had my cystoscopy yesterday and urine was taken before the procedure. Is the urine also taken during the procedure?

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Yes it can. I believe my doctors checked both. But not all doctors do. They do keep a close watch on you. Good luck and try to relax and know that you are in good hands. God Bless Hon, xxoo Buddygramma

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are papillary clusters considered synonymous with atypical cells?

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The short answer is no. Atypical cells may be atypical based on size and darkness of nuclei, nuclear irregularity, abnormal ratio of nuclear size to cell size, without being in papillary clusters or clusters at all and papillary clusters may show little in the way of cytologic atypia. That distinction aside, having true papillary structures, particularly in a voided urine without prior or current instrumentation, is an abnormal finding and would be most likely regarded as at least atypical, I would think.


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