What Do Men Have Over Women?
Clean Catch Urine Specimens!
For men - simply unzip, uncover, if needed, point and aim. For a woman, it is much more difficult. The proper urine collection requires: 1. Opening the wipes and taking off the top of the specimen container and placing them close to the toilet. The woman, if wearing slacks, needs to pull them down to the ankles followed by panties. Then, with her legs wide apart, using one hand to hold the vagina open, take the wipe and wipe from front downward toward the back. And continuing to hold the vagina open, place the cup and begin collecting the urine specimen.
Why is this important?
A significant number of women do not do this correctly and provide contaminated urine because it touches the vagina on the way out. Results - positive dipsticks for nitrates, white blood cells and positive urine cultures or contaminated urine cultures. It is not uncommon for us to see patients referred for current or resistant urinary tract infections frequently symptomatic and frequently having been on multiple courses of the same or different antibiotics.
The tipoff: Epithelial cells on the dipsticks and, if checked on a microscopic examination or urine culture stating contamination.
The remedy: Proper instruction at collection and/or cathed urine collection.
We feel one must be careful in just assuming the dipstick, especially in an asymptomatic or history of a current infection, shows a urinary tract infection without at least doing a culture.
We realize that most PCPs don't have the ability to do cath urine specimens in their office. When you refer to urologist with difficult cases, we routinely do cultures and when appropriate, do cath specimens. We will be happy to do so for any of your patients who you deem worthwhile.
Take Home Message
If the dipstick does show epithelial cells, and/or if your patient is asymptomatic, at the minimum, do a culture and certainly consider the possibility of a contaminated urine specimen. And then with epithelial cells on a specimen, make sure they retracted their foreskin, if uncircumcised, before giving a specimen.
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