The simplicity and noninvasive nature of urinalysis suggests that this tool will remain an essential part of our diagnostic and screening armamentarium for many years. A major drawback of urinalysis is insufficient sensitivity and specificity for the detection of some diseases (including malignancies, stones and infections) in different populations. Nevertheless, there are promising developments: with regard to life-threatening bladder tumors, recent studies have presented numerous new markers that may improve detection when compared with urine cytology alone. For example, cytokeratin 8 and 18 fragments, which can be a urine rapid point-of-care test, are currently being investigated. Future addition of markers such as these to a standard urinalysis could promote the early detection of high-grade aggressive tumors.
Another field in which urinalysis may provide extended data in the future is in the detection of urinary stones. This is extremely important in the obstetric population in which the radiographic detection and treatments are limited. The ability to detect stone trace elements such as calcium, oxalate, urate, cystine, xanthine or phosphate in spot urinalysis could be of great benefit. It would provide additional parameters for the diagnosis of stones, as well as a measure to determine the success of conservative treatments to reduce these components and eliminate urinary stones.
In the diagnosis of UTIs, urinalysis currently relies on the presence of leucocytes and/or nitrites without providing information about the aggressiveness of the pathogen or its susceptibility to antibiotic treatment. The ability of simple urinalysis to detect the presence of specific components, which exist in more virulent bacterial strains, could provide immediate information and influence treatment decisions. This is especially important in obstetrical patients to help prevent maternal and fetal complications. Hopefully in the future, urinalysis technology will also provide a differential sensitivity profile to guide antibiotic therapy.
Expert Rev of Obstet Gynecol. 2012;7(3):269-279. © 2012 Expert Reviews Ltd.