In my pursuit of clinical details for all request forms, I have been asked a few times specifically about urine samples. Why bother adding clinical details for a urine sample that is sent to the lab. Is the request not obvious?

However when you think about it and examine a little more closely there are actually many “less obvious” reasons that a urine sample is sent to the lab. Take the following examples below:

Test of Cure: Once symptoms have settled, this is generally not indicated.

As part of an admission screen: Positive predictive value, even in an elderly patient, must be awful.

Prior to orthopaedic (or other) surgery: With the exception of urological surgery, the evidence is now strongly against this.

Wellness check: Just in case…even if you did culture bacteria, treatment would not be indicated in an asymptomatic patient.

Insurance/Immigration requests: as above.

Looking for proteinuria or glucose: In diabetics. Requestor not interested in culture result.

Looking for haematuria: If lab not aware, likely to increase risk of false negative due to sub-optimal testing.

Cloudy/smelly urine in catheter bag: Sending such a sample to the lab is hardly ever indicated.

So as you can see there are actually many reasons that urine samples sent to the lab. There are probably many more which I have not thought of from the top of my head. Many are inappropriate, others are nothing whatsoever to do with infection.

With regards to patients with “symptoms”, there can be a whole range of clinical scenarios, from acute dysuria and frequency to non-specific fatigue. Each set of symptoms will have a different pre-test probability and will therefore potentially affect how the test is reported and interpreted, particularly for borderline results.

And then there all the supporting clinical details which may affect how the test is processed and reported, e.g. pregnancy, immunocompromise, antibiotic allergies, presence of catheter, presence of urinary stents etc etc..

So if someone says to you there is no point in submitting clinical details for urine specimens, I would strongly object to this for all of the reasons above.

In short there is no excuse for not submitting clinical details, not for urine samples or any other samples. Don’t let anyone tell you otherwise….

Michael