Urine collection techniques in infants and children with suspected urinary tract infection
- Lalit Bajaj, MD, MPH
Lalit Bajaj, MD, MPH
- Associate Professor of Pediatrics and Emergency Medicine
- 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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The procedures for obtaining and processing urine samples in infants and children are reviewed here. The diagnosis, treatment, and subsequent evaluation of urinary tract infections in neonates, infants, and older children are discussed separately:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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.
- Labrosse M, Levy A, Autmizguine J, Gravel J. Evaluation of a New Strategy for Clean-Catch Urine in Infants. Pediatrics 2016; 138.
- 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.
- Ballouhey Q, Fourcade L, Couve-Deacon E, et al. Urine Contamination in Nontoilet-trained and Uncircumcised Boys. Urology 2016; 95:171.
- 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.
- 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.
- 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.
- 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.
- Wald ER. To bag or not to bag. J Pediatr 2005; 147:418.
- Stein R, Dogan HS, Hoebeke P, et al. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015; 67:546.
- Lavelle JM, Blackstone MM, Funari MK, et al. Two-Step Process for ED UTI Screening in Febrile Young Children: Reducing Catheterization Rates. Pediatrics 2016; 138.
- Finnell SM, Carroll AE, Downs SM, Subcommittee on Urinary Tract Infection. Technical report—Diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics 2011; 128:e749.
- 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.
- Herreros Fernández ML, González Merino N, Tagarro García A, et al. A new technique for fast and safe collection of urine in newborns. Arch Dis Child 2013; 98:27.
- Tran A, Fortier C, Giovannini-Chami L, et al. Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department. PLoS One 2016; 11:e0152598.
- Kaufman J, Fitzpatrick P, Tosif S, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ 2017; 357:j1341.
- Chen L, Hsiao AL, Moore CL, et al. Utility of bedside bladder ultrasound before urethral catheterization in young children. Pediatrics 2005; 115:108.
- Chua ME, Firaza PNB, Ming JM, et al. Lidocaine Gel for Urethral Catheterization in Children: A Meta-Analysis. J Pediatr 2017; 190:207.
- Gerard LL, Cooper CS, Duethman KS, et al. Effectiveness of lidocaine lubricant for discomfort during pediatric urethral catheterization. J Urol 2003; 170:564.
- Beno S, Schwab S. Bladder catheterization. In: Textbook of Pediatric Emergency Procedures, 2nd ed, 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.
- 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 ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1861.
- Gochman RF, Karasic RB, Heller MB. Use of portable ultrasound to assist urine collection by suprapubic aspiration. Ann Emerg Med 1991; 20:631.
- 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 ed, 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
- - Specimen for urine culture
- - Specimen for urine dipstick or urinalysis
- Clean voided samples
- Transurethral bladder catheterization
- Suprapubic aspiration
- PROCESSING OF URINE SAMPLES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS