URINE SAMPLING METHOD The ideal voided urine sample for evaluation of UTI is one

that accurately represents the bladder bacterial count with minimized contamination by bacteria
colonizing the distal urethra and genital mucosa. Theoretically this would be a clean-catch,
midstream sample of the first micturition of the day. In fact, there is no clinical evidence that this
ideal specimen yields more accurate results. Collection of a midstream urine, with or without
cleaning of the urethral meatus, at the time of clinical evaluation likely produces a reasonable
specimen for analysis

The likelihood of detecting a bladder bacteriuria by voided urine culture is highest if urine is
collected on arising. This sample is likely to be most concentrated and bacteria in the bladder
will have had time to multiply overnight. However, this ideal sample is not practical since most
cultures are obtained at the time the patient is seeing the clinician. With samples collected later
in the day, the combination of a more dilute urine and partial bacterial washout due to multiple
voids may lower the colony count below the accepted definition for bacteriuria diagnostic of a
UTI.

An optimal clean-catch, midstream urine is collected through the following steps in attempts to
minimize the degree of contamination with bacteria from the urethra:

Local disinfection of the meatus and adjacent mucosa should be performed with a non-
foaming antiseptic solution, such as Dakins solution (diluted sodium hypochlorite
solution 0.5%); this region should then be dried with a sterile swab to avoid mixture of the
antiseptic with urine.

Contact of the urinary stream with the mucosa should be minimized by spreading the
labia in females and by pulling back the foreskin in uncircumcised males.

The initial stream of the voided specimen should be discarded since the initial urine
flushes urethral contaminants. It is the subsequent midstream sample that should be sent
to the laboratory.

However, clinical studies do not demonstrate that cleaning the meatus is associated with lower
rates of contamination.Thus, for patients in whom the cleaning step may be impractical or
difficult, a midstream urine collected (with the labia spread, for women) is likely an
appropriate sample