Bladder Infection Diagnosis and Tests

Urology: Urinary & Reproductive Disease Diagnosis & Treatment

What is Urology?

Urology: Urinary & Reproductive Disease Diagnosis & Treatment

Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.

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Diagnostic Protocol at Liv Hospital

Diagnostic Protocol at Liv Hospital

Our diagnostic approach prioritizes accuracy to facilitate Antimicrobial Stewardship. We distinguish between “contamination,” “colonization,” and “infection,” and aim to identify the causative organism’s resistance profile to avoid treatment failure.

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Urine Microscopy (The Cellular Analysis)

Urine Microscopy (The Cellular Analysis)

If the dipstick is equivocal, the urine is centrifuged and examined under a microscope.

  • Pyuria: Defined as ≥ 10 WBCs per high-power field (hpf). This is the hallmark of inflammation.
  • Sterile Pyuria: Presence of WBCs without visible bacteria. This differential includes: Chlamydia, Tuberculosis, Kidney Stones, Interstitial Cystitis, or Urothelial Carcinoma (CIS).
  • Bacteriuria: Direct visualization of bacteria.
  • Hematuria: Presence of Red Blood Cells. Dysmorphic RBCs suggest glomerular disease; normal RBCs suggest lower tract bleeding.
  • Squamous Epithelial Cells: >5 cells/hpf indicates the sample was contaminated by skin/vaginal flora during collection (“Dirty Catch”), rendering the culture results unreliable.
  • White Blood Cell Casts: Cylindrical structures formed in the renal tubules. Their presence proves the infection originated in the kidney (Pyelonephritis), not just the bladder.
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Urinalysis (The Bedside Test)

Urinalysis (The Bedside Test)

This is the first-line screening tool. A dipstick is immersed in a fresh, clean-catch midstream urine sample.

  • Leukocyte Esterase (LE): An enzyme released by broken neutrophils. A positive LE test indicates pyuria (inflammation). Sensitivity: 75-96%. False Positives: Vaginal contamination. False Negatives: Very dilute urine.
  • Nitrites: Many gram-negative bacteria (like E. coli, Klebsiella, Proteus) convert urinary nitrate (derived from diet) into nitrite. A positive nitrite test is specific (>95%) for a bacterial infection. However, sensitivity is lower because:
    • Some bacteria (Enterococcus, Staphylococcus, Pseudomonas) do not produce nitrites.
    • The urine may not have been in the bladder long enough (about 4 hours) for the conversion to occur.
  • Blood (Hemoglobin): Detects microscopic hematuria.
  • pH: High pH (>7.5) strongly suggests infection with urea-splitting organisms like Proteus.
  • Specific Gravity: Measures urine concentration. Very dilute urine can cause false-negative chemical tests.
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Urine Culture and Antibiogram (The Gold Standard)

Urine Culture and Antibiogram (The Gold Standard)

This involves plating the urine on agar growth media (Blood agar and MacConkey agar) and incubating for 24-48 hours.

  • Indications: Required for all complicated UTIs, recurrent infections, pyelonephritis, men, pregnant women, children, and cases where empirical treatment failed.
  • Quantification: The traditional diagnostic threshold is ≥105 Colony Forming Units (CFU) per mL. However, this definition is evolving. In symptomatic women (“Acute Urethral Syndrome”), counts as low as 102 to 103 CFU/mL of a single uropathogen are clinically relevant.
  • Identification: Mass Spectrometry (MALDI-TOF) enables rapid identification of species within minutes of colony growth.
  • Susceptibility Testing (Antibiogram): The isolated pathogen is tested against a panel of antibiotics. Results are reported as S (Sensitive), I (Intermediate), or R (Resistant). This guides “de-escalation” from empirical broad-spectrum therapy to targeted narrow-spectrum therapy.
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Cystoscopy

Cystoscopy

Given the complexity of these systems, urology has branched into several highly specialized fields:

  • Urologic Oncology: Focuses on cancers of the urinary system, including bladder, kidney, prostate, and testicular cancer.
  • Endourology: Deals with closed manipulation of the urinary tract. This involves using small cameras and instruments inserted into the urinary tract to treat stones or a narrowing without making large incisions.
  • Neurourology: Focuses on urinary problems due to nerve disorders, such as spinal cord injuries, multiple sclerosis, or Parkinson’s disease.
  • Pediatric Urology: Treats urological disorders in children, including undescended testes and vesicoureteral reflux.
  • Andrology: Focuses on male reproductive health, including male infertility and sexual dysfunction.
  • Female Urology: Specializes in conditions like overactive bladder, pelvic organ prolapse, and urinary incontinence in women.
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Clinical Assessment and History

Clinical Assessment and History
  • PCR (Polymerase Chain Reaction): Used for rapid detection of sexually transmitted pathogens (Chlamydia, Gonorrhea) or fastidious organisms (Mycoplasma, Ureaplasma) that do not grow on standard cultures.
  • Next-Generation Sequencing (NGS): Emerging technology that sequences all DNA in urine. It can detect polymicrobial infections and anaerobes within biofilms that are missed by standard culture methods. Valuable in chronic, culture-negative cystitis.
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Advanced Molecular Diagnostics

Advanced Molecular Diagnostics
  • Pre-test Probability: In a premenopausal woman with classic symptoms (dysuria, frequency, urgency) and no vaginal discharge/irritation, the probability of cystitis is >90%. Guidelines often support diagnosis based on history alone in this specific group.
  • Complex History: We evaluate for “Complicating Factors”: fever, flank pain, pregnancy, diabetes, history of childhood urinary surgery, recent instrumentation, or symptoms lasting >7 days.
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Imaging Modalities

Imaging Modalities

Imaging is not indicated for a first episode of uncomplicated cystitis. It is reserved for:

  • Recurrent infections.
  • Pyelonephritis (to rule out abscess, obstruction, or gas).
  • Persistent hematuria.
  • Severe symptoms (colic, fever) or renal failure.
  • Renal/Bladder Ultrasound: Non-invasive. Assesses for hydronephrosis (obstruction), kidney stones, bladder wall thickness, diverticula, and crucially, Post-Void Residual (PVR) volume (how much urine is left after peeing).
  • CT Urography (CTU): The definitive imaging study. It provides high-resolution views of the entire tract (stones, tumors, abscesses, and anatomical variants, such as duplicated ureters).
  • Voiding Cystourethrogram (VCUG): Used in children to diagnose Vesicoureteral Reflux.

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Assoc. Prof. MD. Buğra Bilge Keseroğlu Assoc. Prof. MD. Buğra Bilge Keseroğlu Urology
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