Evaluating the Role of Urine Cytology in Haematuria One-Stop Clinics: A Scoping Review of Current Evidence and Clinical Utility.

Urine cytology has traditionally been part of haematuria assessment pathways for detecting high-grade urothelial carcinoma, particularly carcinoma in situ (CIS), but its value within modern Haematuria One-Stop Clinics (HOSCs) is increasingly debated in light of new diagnostic approaches, economic pressures, and updated international guidelines. This scoping review takes into account current evidence and recommendations from the American Urological Association (AUA), European Association of Urology (EAU), British Association of Urological Surgeons (BAUS), and National Institute for Health and Care Excellence (NICE), drawing on four extensive peer-reviewed studies to assess the diagnostic accuracy, clinical relevance, and cost-effectiveness of urine cytology in one-stop haematuria models. Across all major guidelines, there is consensus that urine cytology should not be routinely used in the initial evaluation of haematuria, with selective use reserved for patients at risk of CIS or with equivocal cystoscopy findings. While cystoscopy and cross-sectional imaging remain the principal diagnostic tools, variation in practice persists, particularly in the UK, due to established custom, resource limitations, and medico-legal considerations. Urine cytology retains a limited, targeted role in detecting high-grade disease, but its routine use in HOSCs lacks robust supporting evidence; standardising practice in line with international guidance will promote risk-stratified, cost-effective, and consistent haematuria management.