Cytological examination of urine in the differential diagnosis of recurrent lower urinary tract infection


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Introduction. A diagnosis and treatment of recurrent lower urinary tract infection (UTI) in women is still one of the unresolved problems of urology. The proper identification of the etiological factor determines the treatment tactics. Therefore, the most urgent issue of recurrent lower UTI is the differential diagnosis of the causative pathogens.

Materials and methods. A cytological study of urine was performed in 151 patients with recurrent lower UTI, who, according to the results of bacteriological and PCR studies of urine, were divided into three groups, depending on the etiological factor. The group 1 (n=70) included women with recurrent lower UTI of bacterial etiology, while in group 2 (n= 70) papillomavirus etiology was found, and in group 3 (n=11) candida species were the causative pathogens. The age of the patients ranged from 20 to 45 years (32.3±7.8).

Results. In the majority of patients with recurrent lower UTI of bacterial etiology, the cytological features were represented by leukocytes, plasma, epithelial cells and bacteria in combination with actively phagocytic macrophages. In group 3, in addition to a large number of leukocytes (neutrophils) and epithelial cells, Candida mycelium was found. In group 2, signs of bacterial inflammation were minimal, while a predominance of lymphocytes, epithelial cells, and the presence of single neutrophils was seen. With papillomavirus lesions of the bladder, urothelial cell dystrophy with the presence of koilocytes developed.

Conclusions: A cytological examination of urine can confirm the etiology of the recurrent lower UTI and be an evidence-based criterion in the differential diagnosis of bacterial, candidiasis, and papillomavirus infection. Total transformation of the urothelium and vacuolization of urothelial cells, as well as an excess of lymphocytes in the urine in the absence of neutrophils, are the characteristic features of viral recurrent lower UTI.

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作者简介

Kh. Ibishev

Rostov State Medical University, Ministry of Health of the Russian Federation

编辑信件的主要联系方式.
Email: Ibishev22@mail.ru

Ph.D., MD, Professor of the Department of Urology and Human Reproductive Health (with a course of pediatric urology and andrology)

俄罗斯联邦, Rostov-on-Don

M. Mamedov

Rostov State Medical University, Ministry of Health of the Russian Federation

Email: mamedov1007@yandex.ru
ORCID iD: 0000-0001-5508-4510

urologist, Ph.D. student of the Department of Urology and Human Reproductive Health (with a course of pediatric urology and andrology)

俄罗斯联邦, Rostov-on-Don

Yu. Naboka

Rostov State Medical University, Ministry of Health of the Russian Federation

Email: nula33@mail.ru
ORCID iD: 0000-0002-4808-7024

Ph.D., MD, professor, Head of the Department of Microbiology and Virology No.1

俄罗斯联邦, Rostov-on-Don

Kh. Ilyasov

Rostov State Medical University, Ministry of Health of the Russian Federation

Email: hasayn0@mail.ru
ORCID iD: 0000-0003-0223-8234

Resident of the Department of Urology and Human Reproductive Health (with a course of pediatric urology and andrology)

俄罗斯联邦, Rostov-on-Don

M. Kogan

Rostov State Medical University, Ministry of Health of the Russian Federation

Email: dept_kogan@mail.ru
ORCID iD: 0000-0002-1710-0169

Honored Scientist of the Russian Federation, Ph.D., MD, Professor; Head of the Department of Urology and Human Reproductive Health with the course of pediatric urology and andrology

俄罗斯联邦, Rostov-on-Don

参考

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2. Fig.1 Light microscopy. Leukocytes (neutrophils), bacteria epithelial cells>10x1. Magnification x200

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3. Fig.2. Light microscopy. Leukocytes (neutrophils), epithelial cells>10x1. Mycelium of Candida spp. Magnification x200.

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4. Fig.3. Indicators (%) of leukocytes in the urine of patients of the studied groups

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5. Fig.4. Light microscopy. epithelial cells. Stained with hematoxylin and eosin. Zoom x1000

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6. Fig.5. Light microscopy. Single urothelial cells in the field of view. A single koilocyte in the field of view. Stained with hematoxylin and eosin. Zoom x1000

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7. Fig.6. Assessment of urothelial dystrophy in the study groups

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