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Test Code Non-Gynecologic Request Form Cytology, Urinary Tract

Methodology

Includes routine cytologic evaluation on microscopic slides and a cell block, whenever possible.

Performing Laboratory

Peninsula Regional Medical Center - Pathology

Specimen Requirements

Acceptable Specimens:
Bladder washing, catheterized urine, renal pelvic washing or brushing, ureteral washing or brushing, or voided urine.

 

Urine may contain cells exfoliated from cancer of bladder, kidney, renal pelvis, or ureter. Multiple specimens will increase test sensitivity.

 

Specimen Collection

1. Label a 120 mL sterile, specimen container with patient’s full first and last name, date of birth, date of collection, specimen source, and submitting physician’s name.

2. Have patient void into a sterile, screw capped specimen cup.

3. Deliver to Histology Department immediately. If there is a delay in transport, send specimen refrigerated.

4. Specimen rejection criteria is based on improper specimen labeling, collection, handling, or submission.

A. Frozen specimen

B. Specimen that is contaminated on outside of collection container

C. Specimen that has leaked into plastic biohazard bag

D. No non-gynecologic cytology requisition form

E. Name on requisition does not match name on specimen container

F. Unlabeled specimen container. Two patient identifiers are required on specimen container.

G. No physician’s name

H. If rejection compromises patient care (one-time specimen such as pelvic washing or STAT request) laboratory personnel will contact a pathologist to determine if specimen will be tested.

5. Label specimen container with patient’s full first and last name, date of birth, date of collection, specimen source, and submitting physician’s name.

6. Complete a non-gynecologic cytology requisition form. Include the following information:

A. Patient’s full first and last name

B. Date of birth

C. Medical record or Social Security number

D. Date of collection

E. Submitting physician’s name. Include names of physicians to receive cytology report copies.

F. Specimen source

G. Pertinent clinical information

7. Place specimen in a plastic biohazard bag and insert non-gynecologic cytology requisition form into separate paper pouch.