What is the role of lab tests in the preoperative workup for radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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See the list below:

  • Urinalysis

    • Urinalysis is used to identify or to confirm microscopic or gross hematuria. When hematuria is present along with bacteruria or pyuria, obtain a urine culture to rule out urinary tract infection.

    • Urinalysis may yield false-negative results because hematuria associated with bladder cancer is often intermittent.

  • Urine cytology

    • Exfoliated urothelial cells are viewed using microscopy. In some urothelial cancers, cellular clumping, a high nuclear-to-cytoplasmic ratio, nucleoli, and atypia are seen.

    • Avoid the first morning sample because of cellular degeneration.

    • Cytology is useful for identifying CIS and high-grade tumors but is less useful for low-grade tumors.

    • The sensitivity of cytology for grades 1, 2, and 3 disease is 20%, 50%, and 90%, respectively.

    • Tests that are used to assess for protein (NMP22), nucleic acid, or chromosomal abnormalities (chromosomes 3, 7, 9, 17) are emerging as possible urine-based adjuncts for the diagnosis of bladder cancer.

  • Bladder barbotage

    • Bladder barbotage consists of repeated washings of bladder urothelium with normal saline.

    • This test has better sensitivity than urine cytology because the total yield of cells is higher.

  • Liver function tests and bony fraction of alkaline phosphatase: These tests are used to evaluate for metastatic spread to liver and bone.

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