Urine collection techniques in infants and children with suspected urinary tract infection
- Lalit Bajaj, MD, MPH
Lalit Bajaj, MD, MPH
- Associate Professor of Pediatrics
- Children's Hospital Colorado
- Joan Bothner, MD
Joan Bothner, MD
- Professor of Pediatrics and Emergency Medicine
- University of Colorado School of Medicine
- Section Editor
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The procedures for obtaining and processing urine samples in children are reviewed here. The diagnosis, treatment, and subsequent evaluation of urinary tract infections (UTIs) in neonates, infants, and older children are discussed separately. (See "Urinary tract infections in neonates" and "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis" and "Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis" and "Urinary tract infections in children: Long-term management and prevention".)
The likelihood of a urinary tract infection (UTI) varies significantly in the pediatric population according to age, sex, race, circumcision status in males, and presenting signs and symptoms. Although clinicians may have variable thresholds for diagnostic testing, urine samples for urinalysis (dipstick and microscopic examination) and culture are generally indicated when the probability of a urinary tract infection is greater than 2 percent. Thus, they are appropriate in the following pediatric patients (algorithm 1A-C and table 1) (see "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis", section on 'Decision to obtain'):
●Girls and uncircumcised boys younger than two years with at least one risk factor for UTI (history of UTI, temperature >39°C, fever without apparent source [particularly if the child will be treated with antibiotics], ill appearance, suprapubic tenderness, fever >24 hours, or nonblack race)
●Circumcised boys younger than two years with suprapubic tenderness or at least two risk factors for UTI (history of UTI, temperature >39°C, fever without apparent source [particularly if the child will be treated with antibiotics], ill appearance, suprapubic tenderness, fever >24 hours, or nonblack race)
●Girls and uncircumcised boys older than two years with any of the following urinary symptoms: abdominal pain, back pain, dysuria, frequency, high fever, or new-onset incontinence
- Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011; 128:595.
- Al-Orifi F, McGillivray D, Tange S, Kramer MS. Urine culture from bag specimens in young children: are the risks too high? J Pediatr 2000; 137:221.
- Tosif S, Baker A, Oakley E, et al. Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J Paediatr Child Health 2012; 48:659.
- Karacan C, Erkek N, Senel S, et al. Evaluation of urine collection methods for the diagnosis of urinary tract infection in children. Med Princ Pract 2010; 19:188.
- Pollack CV Jr, Pollack ES, Andrew ME. Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates. Ann Emerg Med 1994; 23:225.
- Tobiansky R, Evans N. A randomized controlled trial of two methods for collection of sterile urine in neonates. J Paediatr Child Health 1998; 34:460.
- Stamm WE, Wagner KF, Amsel R, et al. Causes of the acute urethral syndrome in women. N Engl J Med 1980; 303:409.
- PRYLES CV, ATKIN MD, MORSE TS, WELCH KJ. Comparative bacteriologic study of urine obtained from children by percutaneous suprapubic aspiration of the bladder and by catheter. Pediatrics 1959; 24:983.
- Hardy JD, Furnell PM, Brumfitt W. Comparison of sterile bag, clean catch and suprapubic aspiration in the diagnosis of urinary infection in early childhood. Br J Urol 1976; 48:279.
- Wingerter S, Bachur R. Risk factors for contamination of catheterized urine specimens in febrile children. Pediatr Emerg Care 2011; 27:1.
- Dayan PS, Chamberlain JM, Boenning D, et al. A comparison of the initial to the later stream urine in children catheterized to evaluate for a urinary tract infection. Pediatr Emerg Care 2000; 16:88.
- Gochman RF, Karasic RB, Heller MB. Use of portable ultrasound to assist urine collection by suprapubic aspiration. Ann Emerg Med 1991; 20:631.
- Vaillancourt S, McGillivray D, Zhang X, Kramer MS. To clean or not to clean: effect on contamination rates in midstream urine collections in toilet-trained children. Pediatrics 2007; 119:e1288.
- Gerard LL, Cooper CS, Duethman KS, et al. Effectiveness of lidocaine lubricant for discomfort during pediatric urethral catheterization. J Urol 2003; 170:564.
- Vaughan M, Paton EA, Bush A, Pershad J. Does lidocaine gel alleviate the pain of bladder catheterization in young children? A randomized, controlled trial. Pediatrics 2005; 116:917.
- Poonai N, Li J, Langford C, et al. Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial. Pediatrics 2015; 136:e879.
- Beno S, Schwab S. Bladder catheterization. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.888.
- Faasse MA, Maizels M. Catheterization of the urethra in girls. N Engl J Med 2014; 371:1849.
- Chen L, Hsiao AL, Moore CL, et al. Utility of bedside bladder ultrasound before urethral catheterization in young children. Pediatrics 2005; 115:108.
- Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics 1999; 103:843.
- Ruddy RM. Illustrated techniques of pediatric emergency procedures. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1861.
- King C, Henretig FM. Bladder catheterization and suprapubic bladder aspiration. In: Pocket Atlas of Pediatric Emergnecy Procedures, King C, Henretig FM. (Eds), Lippincott Williams and Wilkins, Philadelphia 2000. p.257.
- NELSON JD, PETERS PC. SUPRAPUBIC ASPIRATION OF URINE IN PREMATURE AND TERM INFANTS. Pediatrics 1965; 36:132.
- Hertz AL. Urinary tract infection. In: Pediatric Emergency Medicine Concepts and Clinical Practice, 2nd, Barkin R. (Ed), Mosby, St. Louis 1997. p.1164.
- Carlson KP, Pullon DH. Bladder hemorrhage following transcutaneous bladder aspiration. Pediatrics 1977; 60:765.
- Saccharow L, Pryles CV. Further experience with the use of percutaneous suprapubic aspiration of the urinary bladder. Bacteriologic studies in 654 infants and children. Pediatrics 1969; 43:1018.
- Polnay L, Fraser AM, Lewis JM. Complication of suprapubic bladder aspiration. Arch Dis Child 1975; 50:80.
- Weathers WT, Wenzl JE. Suprapubic aspiration of the bladder. Perforation of a viscus other than the bladder. Am J Dis Child 1969; 117:590.
- Graham JC, Galloway A. ACP Best Practice No 167: the laboratory diagnosis of urinary tract infection. J Clin Pathol 2001; 54:911.
- SELECTION OF TECHNIQUE
- Toilet trained
- Not toilet trained
- Clean voided samples
- Transurethral bladder catheterization (TUBC)
- - Boys
- - Girls
- - Portable ultrasound
- - Complications
- Suprapubic bladder aspiration (SPA)
- - Portable ultrasound
- - Complications
- Clean voided bag samples
- PROCESSING OF URINE SAMPLES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS