Do external urine collection devices reduce contamination in urine samples for women with symptoms of urinary tract infection? A systematic review / ¿Reducen los dispositivos externos de recogida de orina la contaminación de las muestras de orina en mujeres con síntomas de infección urinaria? Una revisión sistemática

Introduction: To evaluate the impact of external urine collection devices (UCD) on contamination of urine samples in women with symptoms of urinary tract infection. Methods: This review was conducted according to the Systematic Reviews of Diagnostic Test Accuracy guidelines (PROSPERO CRD42021241758). PubMed was searched for paired sample studies and controlled trials. Studies comparing UCDs with non-invasive urine collection procedures were considered. Results: Only two studies were found. Neither of the two studies found any difference regarding contamination between specimens collected with the UCDs compared and non-invasive techniques. In the largest study, including 1264 symptomatic women, 18.8% of those allocated to UCDs failed to collect urine samples successfully. Conclusions: More studies involving women with symptoms of urinary tract infection are needed to produce more robust data on the impact of these devices on urine contamination rates.

Introducción: Evaluar el impacto de los dispositivos externos de recogida de orina (DERO) sobre la contaminación en muestras de orina en mujeres con síntomas de infección urinaria. Métodos: Esta revisión siguió la pauta de revisiones sistemáticas de pruebas diagnósticas (PROSPERO CRD42021241758). Se realizó una búsqueda en PubMed de estudios de muestras pareadas y ensayos controlados. Se consideraron los estudios que compararon los DERO con procedimientos no invasivos de recogida de orina. Resultados: Solo se hallaron 2 estudios. Ninguno encontró diferencia alguna en la contaminación de las muestras recogidas con DERO y técnicas no invasivas. En el estudio más grande, que incluyó a 1.264 mujeres sintomáticas, el 18,8% de las asignadas a los DERO no pudieron recoger las muestras satisfactoriamente. Conclusiones: Se necesitan más estudios con mujeres con síntomas de infección urinaria para tener datos más consistentes del impacto de estos dispositivos sobre la contaminación de las muestras urinarias.(AU)

Clean-Catch Urine Specimen More Likely to Be Contaminated After Vaginal Surgery for Pelvic Organ Prolapse.

IMPORTANCE: Accurate diagnosis of urinary tract infection after pelvic organ prolapse (POP) surgery is essential to postoperative care. OBJECTIVE: Our aim was to determine the agreement between the urinalysis of a clean-catch versus a straight catheter urine specimen in women who underwent vaginal surgery for POP. STUDY DESIGN: This was a cross-sectional study evaluating patients after vaginal surgery for POP. A clean-catch and straight catheter urine specimen were collected at routine postoperative appointments. Routine urinalyses and urine cultures were performed for all patients. A urine culture yielding mixed urogenital flora (which includes Lactobacillus species), coagulase-negative staphylococci, and Streptococcus species was considered a contaminated result. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter at 3 weeks postoperatively was evaluated using weighted κ statistic. RESULTS: Fifty-nine participants enrolled. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter was poor (κ = 0.018). The urine culture was more likely to be contaminated from the clean-catch urine specimen than from the straight catheter urine specimen (53.7% vs 23.1%).The positive and negative predictive values of leukocyte esterase on clean catch were 22.6% and 100%, respectively. CONCLUSIONS: Diagnosing urinary tract infection based on contaminated urinalyses may lead to antibiotic overuse and misdiagnosis of postoperative complications. Our results can help educate health care partners and discourage the use of clean-catch urine specimens when assessing women who have recently undergone vaginal surgery.

The impact of urine collection method on canine urinary microbiota detection: a cross-sectional study.

BACKGROUND: The urinary tract harbors unique microbial communities that play important roles in urogenital health and disease. Dogs naturally suffer from several of the same urological disorders as humans (e.g., urinary tract infections, neoplasia, urolithiasis) and represent a valuable translational model for studying the role of urinary microbiota in various disease states. Urine collection technique represents a critical component of urinary microbiota research study design. However, the impact of collection method on the characterization of the canine urinary microbiota remains unknown. Therefore, the objective of this study was to determine whether urine collection technique alters the microbial populations detected in canine urine samples. Urine was collected from asymptomatic dogs by both cystocentesis and midstream voiding. Microbial DNA was isolated from each sample and submitted for amplicon sequencing of the V4 region of the bacterial 16 S rRNA gene, followed by analyses to compare microbial diversity and composition between urine collection techniques. RESULTS: Samples collected via midstream voiding exhibited significantly higher sequence read counts (P = .036) and observed richness (P = .0024) than cystocentesis urine. Bray Curtis and Unweighted UniFrac measures of beta diversity showed distinct differences in microbial composition by collection method (P = .0050, R2 = 0.06 and P = .010, R2 = 0.07, respectively). Seven taxa were identified as differentially abundant between groups. Pasteurellaceae, Haemophilus, Friedmanniella, two variants of Streptococcus, and Fusobacterium were over-represented in voided urine, while a greater abundance of Burkholderia-Caballeronia-Paraburkholderia characterized cystocentesis samples. Analyses were performed at five thresholds for minimum sequence depth and using three data normalization strategies to validate results; patterns of alpha and beta diversity remained consistent regardless of minimum read count requirements or normalization method. CONCLUSION: Microbial composition differs in canine urine samples collected via cystocentesis as compared to those collected via midstream voiding. Future researchers should select a single urine collection method based on the biological question of interest when designing canine urinary microbiota studies. Additionally, the authors suggest caution when interpreting results across studies that did not utilize identical urine collection methods.

Do external urine collection devices reduce contamination in urine samples for women with symptoms of urinary tract infection? A systematic review.

INTRODUCTION: To evaluate the impact of external urine collection devices (UCD) on contamination of urine samples in women with symptoms of urinary tract infection. METHODS: This review was conducted according to the Systematic Reviews of Diagnostic Test Accuracy guidelines (PROSPERO CRD42021241758). PubMed was searched for paired sample studies and controlled trials. Studies comparing UCDs with non-invasive urine collection procedures were considered. RESULTS: Only two studies were found. Neither of the two studies found any difference regarding contamination between specimens collected with the UCDs compared and non-invasive techniques. In the largest study, including 1264 symptomatic women, 18.8% of those allocated to UCDs failed to collect urine samples successfully. CONCLUSIONS: More studies involving women with symptoms of urinary tract infection are needed to produce more robust data on the impact of these devices on urine contamination rates.

Best methods for urine sample collection for diagnostic accuracy in women with urinary tract infection symptoms: a systematic review.

BACKGROUND: Most guidelines recommend a midstream urine (MSU) or a midstream clean-catch (MSCC) sample for urinalysis. However, whether this sample is better than others is still controversial. OBJECTIVES: To assess the most adequate non-invasive method to collect a urine specimen for diagnosing urinary tract infections (UTI) in symptomatic non-pregnant women. METHODS: This review was conducted according to the Systematic Reviews of Diagnostic Test Accuracy guidelines (PROSPERO CRD42021241758). PubMed was searched paired sample studies and controlled trials. Studies comparing MSCC, MSU without cleaning, first-void urine, and random voiding samples were considered. Studies evaluating invasive methods were excluded. The main outcome was diagnostic accuracy of urine cultures. Contamination rates were evaluated. The risk of bias tool for systematic reviews on diagnostic accuracy (QUADAS-2) was assessed. RESULTS: Six studies including 1,010 patients were evaluated. Only two studies used paired samples. No study was considered as having low risk of bias. There was no difference in contamination for MSU specimens collected with or without cleansing and between random void urine collection and MSCC. In one study comparing first-void urine with MSU samples, the contamination rate was lower in the latter, but the gold standard of urine culture was only used for one sampling collection. CONCLUSIONS: To the best of our knowledge, this systematic review is the first to assess the evidence available from different exclusively non-invasive urine sampling. Despite being widely recommended, our review did not find consistent evidence that asking women to provide midstream samples with or without cleansing is better.

Urine is one type of specimen that can be easily collected from a patient. Urinalysis testing can give the doctor valuable information about the presence of an infection in the urine and the type of microorganism causing this infection. The physician can also use the information from urine testing to diagnose and treat other diseases. The collection of the mid-stream of the urination has always been advocated. However, this recommendation has never been proven with good quality studies, and the results of the studies carried out so far have been controversial. In a systematic review, we recently determined that the use of any specimen during urination is as good as midstream collection when patients are requested to provide a urine sample and in terms of quality even specimens collected without proper cleansing are also comparable to mid-stream collection with cleansing. In the present systematic review, we evaluated the most adequate non-invasive method to collect a urine specimen for diagnosing urinary tract infections in symptomatic non-pregnant women. We identified only six studies comparing different urine sampling techniques and we did not observe any difference regarding the quality of the urine between them.

Estimating population level 24-h sodium excretion using spot urine samples in older adults in rural South Africa.

BACKGROUND: South Africa has introduced regulations to reduce sodium in processed foods. Assessing salt consumption with 24-h urine collection is logistically challenging and expensive. We assess the accuracy of using spot urine samples to estimate 24-h urine sodium (24hrUNa) excretion at the population level in a cohort of older adults in rural South Africa. METHODS: 24hrUNa excretion was measured and compared to that estimated from matched spot urine samples in 399 individuals, aged 40-75 years, from rural Mpumalanga, South Africa. We used the Tanaka, Kawasaki, International Study of Sodium, Potassium, and Blood Pressure (INTERSALT), and Population Mean Volume (PMV) method to predict 24hrUNa at the individual and population level. RESULTS: The population median 24hrUNa excretion from our samples collected in 2017 was 2.6 g (interquartile range: 1.53-4.21) equal to an average daily salt intake of 6.6 g, whereas 65.4% of participants had a salt excretion above the WHO recommended 5 g/day. Estimated population median 24hrUNa derived from the INTERSALT, both with and without potassium, showed a nonsignificant difference of 0.25 g (P = 0.59) and 0.21 g (P = 0.67), respectively. In contrast, the Tanaka, Kawasaki, and PMV formulas were markedly higher than the measured 24hrUNa, with a median difference of 0.51 g (P = 0.004), 0.99 g (P = 0.00), and 1.05 g (P = 0.00) respectively. All formulas however performed poorly when predicting an individual's 24hrUNa. CONCLUSION: In this population, the INTERSALT formulas are a well suited and cost-effective alternative to 24-h urine collection for the evaluation of population median 24hrUNa excretion. This could play an important role for governments and public health agencies in evaluating local salt regulations and identifying at-risk populations.

Urine collection methods in precontinent children treated at the paediatric emergency department.

AIM: To describe the urine collection methods used in precontinent children presenting at the Paediatric Emergency Department (PED) and compare results and contamination rates. METHODS: Retrospective observational cohort study that included 1678 urine cultures collected in infants <24 months of age between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex and patient age. RESULTS: In total, 60.4% of samples were collected by clean-catch urine collection (CCUC), 26.4% by urethral catheterisation (UC) and 13.2% by urine bag (UB). Contamination rates were 2.9% (95% CI 1.3, 4.4) for UC, 11.3% (95% CI 9.3, 13.2) for CCUC and 23.4% (95% CI 17.8, 29.0) for UB. Significant differences in contamination rates were found between UC and CCUC in the 6-12-month age group (1.9% [95% CI 0.0-4.0] versus 12.0% [95% CI 7.2-16.8] [p < 0.0009]), and between UC and UB for all ages. CONCLUSIONS: CCUC is the most common method for urine culture collection in infants <24 months of age at the PED in our centre. UC has the lowest contamination rates, but significant differences were only observed between CCUC and UC in the 6-12-month age group. CCUC is a non-invasive alternative for urine collection in infants.

A Method for Estimating 24 h Urinary Sodium and Potassium Excretion by Spot Urine Specimen in Stroke Patients.

Spot urine specimens have been used to estimate 24 h urinary sodium (Na) excretion (24UNaV) and potassium (K) excretion (24UKV). However, the validity is limited for 24UNaV and unknown for 24UKV in stroke patients, using the existing formulas. Herein, we developed and validated a new formula for 24UNaV and 24UKV by spot urine specimens in stroke patients. Spot and 24 h urine samples were collected from 970 stroke patients. The models of 24UNaV and 24UKV were developed using stepwise multivariate linear regression in 689 patients. The performance of different formulas was internally validated in 281 patients at the population and individual levels. The obtained new formulas were: (1) estimated 24UNaV (mmol/day): -0.191 × Age + 4.349 × BMI + 0.229 × SpotNa + 1.744 × SpotNa/Spot creatinine (Cr) + 41.492 (for male); -1.030 × Age + 2.011 × BMI + 0.143 × SpotNa + 1.035 × SpotNa/SpotCr + 147.159 (for female); and (2) estimated 24UKV (mmol/day): -0.052 × Age + 0.410 × BMI + 0.031 × SpotK + 33.280 × Ln (spotK/spot Cr) - 5.789 × Ln (spotNa/spot Cr) - 1.035 (for male); -0.235 × Age + 0.530 × BMI + 0.040 × SpotK + 30.990 × Ln (spot K/spot Cr) - 7.837 × Ln (spotNa/spotCr) + 4.318 (for female). The new formula obtained the lowest mean bias (5.17 mmol/day for 24UNaV and 0.85 mmol/day for 24UKV) and highest proportion at the cutoff under the ±30% level for the estimation of 24UNaV (59.43%) and 24UKV (70.11%). The new formula provides a meaningful exploration to estimate 24UNaV and 24UKV in stroke patients by using spot urine specimens.

Validation of salt intake measurements: comparisons of a food record checklist and spot-urine collection to 24-h urine collection.

OBJECTIVE: Monitoring population salt intake is operationally and economically challenging. We explored whether a questionnaire assessment and a prediction of Na intake from spot-urine could replace or complement the recommended measurement of Na in 24-h urine (24-h U). DESIGN: Compare the agreement of a Na-specific food record checklist (FRCL) and a late-afternoon spot-urine measurement (PM-spot) with 24-h U measurement in estimating Na intake at group level. Each participant's use of these methods extended over 3 d. Agreement was assessed using mean (95 % CI) differences, linear regression models and Bland-Altman plots. SETTING: The validation study was part of a 1-year workplace intervention trial to lower salt intake in Switzerland. PARTICIPANTS: Seventy women and 71 men, aged 21-61 years, completed three FRCL, and acceptable PM-spot and 24-h U samples at baseline (April-October 2015). RESULTS: Mean Na intake estimates varied slightly across methods (3·5-3·9 g/d). Mean Na intake differences from 24-h U were 0·2 (95 % CI (0, 0·5)) g/d for FRCL and 0·4 (95 % CI (0·2, 0·6)) g/d for PM-spot. Linear regression models and Bland-Altmann plots more clearly depicted differences by sex and discretionary salt use. CONCLUSIONS: Although 24-h U remains the best reference method for monitoring Na intake at the population level, PM-spot and FRCL might be more practical instruments for frequent, periodic Na intake assessments. Population-specific prediction models to estimate 24-h U could be developed and evaluated.

The position during urine sample collection from young precontinent children through a bag does not limit contamination rates: Results from a randomized controlled trial: Does infant position influence quality of urine collection?

AIM: Despite its limitation, bag collection is still widely used for a preliminary urine screening test in non-toilet-trained children suspected of febrile urinary tract infection. A previous study conducted by our group raised the hypothesis that the absence of direct contact between urine and the perinea during urine collection could limit urine contamination by perineal flora. The aim of this study was to evaluate the impact of the patient's position during urine collection (upright standing position versus free position) on the rate of contaminated urine samples in non-toilet-trained children with suspected febrile urinary tract infection. METHODS: This prospective, randomized, controlled study took place in seven pediatric emergency departments. Two groups were compared: the intervention group (infants held in an upright standing position during urination) and the control group (free position during urination). RESULTS: Among the 800 pediatric patients randomized to the study, 124 had a urine culture, 60 in the intervention group and 64 in the control group. Among the 124 urine cultures, 12 (9.7%) were contaminated: eight (13.3%) in the intervention group and four (6.3%) in the control group (p = 0.1824). CONCLUSION: The results show that the patient's position does not have a significant impact on the quality of urine samples collected by bag.

Eficacia de las técnicas de estimulación de la micción para la recogida de orina en el lactante: revisión sistemática y metanálisis / Efficacy of bladder stimulation techniques for urine collection from infants: a systematic review and meta-analysis

Introducción. La recogida de orina en el lactante constituye uno de los procedimientos más habituales de los servicios de urgencias. Presentamos una evaluación de las técnicas de estimulación de la micción en lactantes para la recogida no invasiva de orina. Método. Revisión sistemática con metanálisis de estudios experimentales y observacionales publicados (PubMed, CENTRAL, CINAHL, Cuiden y EMBASE) que evalúen la tasa de éxito, el tiempo hasta la micción, el grado de acepta- ción y el riesgo de contaminación, en comparación o no con técnicas sin estimulación. Resultados. Seleccionamos 15 estudios que incluían recién nacidos y lactantes en su mayoría atendidos en servicios de urgencias. La probabilidad de éxito es 2,4 veces mayor (RR 2,47; IC 95%: 1,84 a 3,31; 2 estudios, 234 casos; I2 0%) con estimulación que sin ella. La tasa de éxito es mayor en los recién nacidos con un 81% (IC 95% 72,9 a 89,1%; 6 estudios; 331 casos; I2 73,2%) que en los lactantes, con 51,5% (IC 95% 35,3 a 67,7%; 9 estudios; 809 ca- sos; I2 96,4%). El tiempo medio requerido es de 83 segundos (IC 95%: 65 a 101; 10 estudios; I2 94,3%). La técnica con la mayor tasa de éxito es la de Herreros con un 68,4% (IC 95% 56,2 a 80,7%; I2 95,1%). Conclusiones. Las nuevas técnicas de estimulación de la micción son una buena alternativa para la recogida de orina, especialmente para recién nacidos. Además de reducir el tiempo y aumentar el éxito de la captura, puede disminuir el estrés y el dolor del niño.

Background and objective. Collecting a urine sample from an infant is one of the most frequently performed emergency department procedures. We aimed to evaluate noninvasive bladder stimulation techniques to obtain urine samples from infants. Methods. Systematic review and meta-analysis of published experimental and observational studies indexed in MEDLINE (PubMed Central); the Cumulative Index of Nursing and Allied Health Literature (CINAHL); the Ibero- American index, CUIDEN; and Embase. Eligible studies had to have assessed the success rate of a technique, time until urination, level of acceptance, and risk of contamination. Comparison of a stimulation technique to nonstimulation was not necessary. Results. We selected 15 studies enrolling newborns or older infants. The setting was usually an emergency department. The probability of success was 2.4-fold higher with stimulation than without it (relative risk, 2.47; 95% CI, 1.84–3.31; I2, 0%) in 2 studies. The rate of success was higher in newborns (81%; 95% CI, 72.9%–89.1%) in 6 studies totaling 331 cases (I2, 73.2%) than in older infants (51.5%; 95% CI, 35.3%–67.7%) in 9 studies with 809 cases (I2, 96.4%). The mean time required to obtain a sample was 83 (95% CI, 65–101) seconds in 10 studies (I2, 94.3%). The stimulation technique of Herreros had the highest success rate (68.4%; 95% CI, 56.2%–80.7%; I2 95,1%). Conclusions. New stimulation techniques for taking urine samples from infants are useful, especially in newborns. Advantages are the short time to urination, the high success rate, and the possibility of lowering the infant’s levels of stress and pain.

¿Podemos usar las técnicas de estimulación de la micción siempre que la situación clínica lo permita? / Can we use bladder stimulation whenever the clinical situation allows it?

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Efficacy of bladder stimulation techniques for urine collection from infants: a systematic review and metaô€€Žanalysis. / Eficacia de las técnicas de estimulación de la micción para la recogida de orina en el lactante: revisión sistemática y metanálisis.

OBJECTIVES: Collecting a urine sample from an infant is one of the most frequently performed emergency department procedures. We aimed to evaluate noninvasive bladder stimulation techniques to obtain urine samples from infants. MATERIAL AND METHODS: Systematic review and meta-analysis of published experimental and observational studies indexed in MEDLINE (PubMed Central); the Cumulative Index of Nursing and Allied Health Literature (CINAHL); the Ibero-American index, CUIDEN; and Embase. Eligible studies had to have assessed the success rate of a technique, time until urination, level of acceptance, and risk of contamination. Comparison of a stimulation technique to nonstimulation was not necessary. RESULTS: We selected 15 studies enrolling newborns or older infants. The setting was usually an emergency department. The probability of success was 2.4-fold higher with stimulation than without it (relative risk, 2.47; 95% CI, 1.84-3.31; I2, 0%) in 2 studies. The rate of success was higher in newborns (81%; 95% CI, 72.9%-89.1%) in 6 studies totaling 331 cases (I2, 73.2%) than in older infants (51.5%; 95% CI, 35.3%-67.7%) in 9 studies with 809 cases (I2, 96.4%). The mean time required to obtain a sample was 83 (95% CI, 65-101) seconds in 10 studies (I2, 94.3%). The stimulation technique of Herreros had the highest success rate (68.4%; 95% CI, 56.2%-80.7%; I2 95,1%). CONCLUSION: New stimulation techniques for taking urine samples from infants are useful, especially in newborns. Advantages are the short time to urination, the high success rate, and the possibility of lowering the infant's levels of stress and pain.

OBJETIVO: La recogida de orina en el lactante constituye uno de los procedimientos más habituales de los servicios de urgencias. Presentamos una evaluación de las técnicas de estimulación de la micción en lactantes para la recogida no invasiva de orina. METODO: Revisión sistemática con metanálisis de estudios experimentales y observacionales publicados (PubMed, CENTRAL, CINAHL, Cuiden y EMBASE) que evalúen la tasa de éxito, el tiempo hasta la micción, el grado de aceptación y el riesgo de contaminación, en comparación o no con técnicas sin estimulación. RESULTADOS: Seleccionamos 15 estudios que incluían recién nacidos y lactantes en su mayoría atendidos en servicios de urgencias. La probabilidad de éxito es 2,4 veces mayor (RR 2,47; IC 95%: 1,84 a 3,31; 2 estudios, 234 casos; I2 0%) con estimulación que sin ella. La tasa de éxito es mayor en los recién nacidos con un 81% (IC 95% 72,9 a 89,1%; 6 estudios; 331 casos; I2 73,2%) que en los lactantes, con 51,5% (IC 95% 35,3 a 67,7%; 9 estudios; 809 casos; I2 96,4%). El tiempo medio requerido es de 83 segundos (IC 95%: 65 a 101; 10 estudios; I2 94,3%). La técnica con la mayor tasa de éxito es la de Herreros con un 68,4% (IC 95% 56,2 a 80,7%; I2 95,1%). CONCLUSIONES: Las nuevas técnicas de estimulación de la micción son una buena alternativa para la recogida de orina, especialmente para recién nacidos. Además de reducir el tiempo y aumentar el éxito de la captura, puede disminuir el estrés y el dolor del niño.

Design of automatic urine collection system for medical system applications.

BACKGROUND: The results of urine tests are often affected by improper midstream urine collection time, urine spilling, and urine pollution, all of which can lead to an increase in the test error. OBJECTIVE: To solve this problem, aiming at improving the toilet environment at the hospitals and public physical examination centers, this paper designs an automatic urine collection system. It can automatically adjust the position of the urine cup with an infrared remote controller, or manually, adjust the position of the urine cup in special situations according to the needs of the user. It also has an alarm function. METHODS: The overall size and shape are designed based on the squatting pan, suitable for disposable plastic urine cups of different shapes and sizes. It can realize the automatic collection of midstream urine, manual collection in exceptional cases, emergency stops, and rescue calls. RESULTS: Through the trial survey, there was a significant difference between the statistical results of using the device and not using the device (t= 13.937, P= 0.000). 96% of the subjects thought that the design of the system was reasonable, 22% thought that it was inconvenient to use, and 91.7% of the medical staff thought that the system met the sampling requirements. CONCLUSIONS: Therefore, the trial evaluation is satisfactory, and the proposed collection system is suitable for use in hospitals at all levels and public health examination centers with a large amount of inspection.

Women's information needs around urine testing for urinary tract infections: a qualitative study.

BACKGROUND: Urinary tract infection (UTI) is one of the commonest bacterial infections in general practice, with urine testing a frequent feature of its management. Urinary dipsticks are widely used, with urine culture the reference standard test. To avoid contamination, patients are advised to discard the first part of the urine stream, retaining the midstream part for the sample. This process, however, can be challenging both to explain and to perform. There is a lack of literature investigating women's perceptions and understanding of urine sampling. AIM: To explore women's understanding of urine collection, sample contamination, and how information from samples informed UTI management. DESIGN AND SETTING: Qualitative study embedded in a UK randomised controlled trial (RCT) of urinary collection devices (UCDs) among women attending primary care with a suspected UTI. METHOD: Semi-structured telephone interviews were conducted with 29 women participating in the RCT. Interviews were transcribed and thematically analysed. RESULTS: Participants were not always aware about what midstream samples were and why they were preferable. They also lacked understanding about how urine samples may be contaminated, and sources of contamination. Participants experienced variability in the information received following analysis of their sample. CONCLUSION: Provision of clear information could help provide better urine samples, aiding the diagnosis of UTIs, presenting results with greater clarity, and creating less need for repeat samples. Sharing of information derived from uncontaminated samples may also support better UTI management, helping to reduce unnecessary prescribing and antibiotic resistance.

Chlorhexidine skin cleaning to reduce clean-catch urine contamination in infants: A pilot study.

OBJECTIVE: Clean-catch urine (CCU) samples are frequently contaminated. Our aim was to determine if cleaning with 0.1% chlorhexidine before CCU is a safe and feasible method to reduce contamination. METHODS: Prospective interventional pilot study. Children 1-24 months underwent perigenital skin cleaning with 0.1% chlorhexidine. Primary outcome was contamination rate, and secondary outcomes were parent and clinician satisfaction with the procedure. RESULTS: Twelve of 54 urine samples were contaminated (22%, 95% CI 13-35). Over 90% of parents and clinicians were either 'satisfied' or 'very satisfied'. No adverse events were recorded. CONCLUSION: Cleaning with chlorhexidine solution before CCU is safe and feasible.

Comparing Urine Specimen Collection Methods for Urinalysis and Culture Agreement: A Paired Sample Design.

OBJECTIVES: The primary aim of this study was to determine if results from clean catch urine specimens agree with results from catheterized specimens in a urogynecology patient population. The secondary aim was to identify clinical scenarios in which catheterized specimens are preferred over clean catch specimens. METHODS: Both a midstream clean catch and a catheterized specimen were obtained for each participant. Dipstick urinalysis was performed. If either specimen was positive for nitrites, leukocyte esterase, or blood then both were sent for urine culture.Kappa statistics were calculated to measure agreement between the paired specimen data for the total sample and for stratified samples. We agreed to accept clean catch results as preferable to catheterized results if the κ statistic was 0.7 or greater. RESULTS: Three hundred forty-two participants were enrolled. For all participants, the agreement between the paired samples was strong for nitrite (κ = 0.884), moderate for blood and colony count (both κ = 0.656), weak for culture species (κ = 0.566), and minimal for leukocyte esterase (κ = 0.382). When data were stratified for menopause, vaginal estrogen use, body mass index, and prolapse, there were no clinical scenarios in which the κ values were consistently greater than our accepted value of 0.7. CONCLUSIONS: Our data indicate that catheterized urine specimens should be used in the evaluation of urinary tract infection or microscopic hematuria in the typical patient presenting to a urogynecology office who is often menopausal, overweight, and may have prolapse.

Defining Properly Collected Urine: Thresholds to Improve the Accuracy of Urinalysis for Microscopic Hematuria Evaluation in Women.

PURPOSE: Microscopic hematuria is one of the most common office consults for urologists. While revised guidelines have risk-stratified patients to reduce unnecessary screening, they do not provide guidance concerning specimen quality. We sought to define "properly collected" specimens using catheterized urine samples as a reference to improve the utility of hematuria screening in women. MATERIALS AND METHODS: We prospectively acquired same-visit voided and catheterized urine samples from 46 women referred for microscopic hematuria from September 2016 to March 2020. Characteristics of pre-referral urinalysis were compared to the matched specimens. True microscopic hematuria was defined as ≥3 red blood cells per high power field on catheterization. RESULTS: Catheterized urinalyses had significantly fewer red blood and squamous epithelial cells in comparison to both referral urinalyses (p=0.006, p=0.001, respectively) and same-day void urinalyses (p=0.02, p=0.04, respectively). As no catheterized sample had >2 squamous epithelial cells, we applied this squamous epithelial cell threshold to referral urinalyses for analysis. Addition of this criterion for "properly collected specimen" increased the positive predictive value of referral urinalyses from 46.1% to 68.8% for true microscopic hematuria. Fewer than 2 squamous epithelial cells with elevated RBC was a significant predictor for true microscopic hematuria (p=0.003). CONCLUSIONS: Voided specimens in the urology clinic had significantly lower red blood cells than referral samples, indicating improved collection technique may reduce false positive urinalyses. Matched collection suggested that repeat collection by catheterization in women who present with >2 squamous epithelial cells per high power field on referral urinalysis may prevent unnecessary future work-up.

The Relationships between Water Intake and Hydration Biomarkers and the Applications for Assessing Adequate Total Water Intake among Young Adults in Hebei, China.

Water is an essential nutrient for humans. A cross-sectional study was conducted among 159 young adults aged 18-23 years in Hebei, China. The total drinking fluids and water from food were obtained by 7-day 24 h fluid intake questionnaires and the duplicate portion method, respectively. Pearson's correlation coefficients were performed to determine the relationship between fluid intake and 24 h urinary biomarkers and plasma biomarkers. A multivariable partial least squares (PLS) model was used to identify the key predictors in modeling the total water intake (TWI) with 24 h urine biomarkers. Logistic regressions of the TWI against binary variables were performed, and the receiver operating characteristic curve (ROC) was analyzed to determine the cutoff value of the TWI for the optimal hydration status and dehydration without adjustments to favor either the sensitivity or specificity. In total, 156 participants (80 males and 76 females) completed the study. Strong relationships were found between the total drinking fluids, TWI, and 24 h urine biomarkers among young adults, especially for the 24 h urine volume (r = 0.784, p < 0.001; r = 0.747, p < 0.001) and osmolality (r = -0.589, p < 0.001; r = -0.477, p < 0.001), respectively. As for the FMU and plasma biomarkers, no strong relationships were found. The percentages of the variance in TWI explained by the PLS model with 13 urinary biomarkers were 66.9%. The optimal TWI values for assessing the optimal hydration and dehydration were 2892 mL and 2482 mL for young males, respectively, and 2139 mL and 1507 mL for young females, respectively. Strong relationships were found between the TWI, total drinking fluids, and 24 h urine biomarkers, but not with the FMU and plasma biomarkers, among young adults, including males and females. The 24 h urine biomarkers were more sensitive than the first morning urinary biomarkers in reflecting the fluid intake. The TWI was a reliable index for assessing the hydration statuses for young adults in free-living conditions.