Urine Specimen Types and Collection Methods

Urine analysis (urinalysis) is one of the most common and valuable diagnostic tools in medicine. It
involves the physical, chemical, and microscopic examination of urine. The accuracy and reliability of
urinalysis depend significantly on the proper collection and handling of the urine specimen. Different
types of urine specimens are collected for different purposes, and each requires a specific collection
method to ensure accurate and meaningful results. This guide will provide a detailed explanation of
these aspects.

I. Why Collect Urine Specimens?

Urine specimens are collected for a wide range of reasons, including:

• Diagnosis of Urinary Tract Infections (UTIs): The most common reason. Urinalysis can detect the
presence of bacteria, white blood cells, and red blood cells, all indicators of infection. A urine culture can
identify the specific bacteria causing the infection and determine the most effective antibiotic.

• Detection and Monitoring of Kidney Disease: Urinalysis can reveal abnormalities in protein, glucose,
blood, and other substances that indicate kidney damage or dysfunction. It can also help monitor the
progression of kidney disease and the effectiveness of treatment.

• Screening for Diabetes Mellitus: Glucose in the urine (glucosuria) is a classic sign of uncontrolled
diabetes. Urinalysis is often used as a screening tool for diabetes, although blood glucose tests are more
accurate.

• Detection of Metabolic Disorders: Certain metabolic disorders can cause abnormal substances to be
excreted in the urine, such as ketones (in diabetic ketoacidosis) or amino acids (in phenylketonuria).

• Drug Screening: Urine is commonly used for drug testing because many drugs and their metabolites
are excreted in the urine.

• Monitoring Pregnancy: Urine pregnancy tests detect the presence of human chorionic gonadotropin
(hCG), a hormone produced during pregnancy.

• Detection of Systemic Diseases: Many systemic diseases, such as lupus or multiple myeloma, can
affect the kidneys and cause abnormalities in the urine.

• Assessment of Hydration Status: Urine color and specific gravity can provide clues about a person's
hydration level.

• Detection of Bladder Cancer: Microscopic examination of urine can sometimes detect cancerous cells
shed from the bladder lining.
• Monitoring Therapeutic Drug Levels: For certain medications, monitoring the drug concentration in
urine is necessary to ensure therapeutic effectiveness and prevent toxicity. Examples include certain
antibiotics and immunosuppressants.

• Research Purposes: Urine samples are frequently used in research to study various aspects of human
health and disease.

II. Types of Urine Specimens

The type of urine specimen collected depends on the specific clinical question being asked. Here's a
detailed look at the different types:

1. Random Urine Specimen:

• Description: This is the most commonly collected type of urine specimen. It's collected at any time of
day, without any specific preparation.

• Collection Method: The patient urinates into a clean container. No special cleaning is required.

• Advantages: Easy and convenient to collect.

• Uses: Screening for abnormalities, routine urinalysis, drug testing, pregnancy testing (qualitative),
and sometimes for microscopic examinat

ion.

2. First Morning Urine Specimen:

• Description: This specimen is collected first thing in the morning, after waking up. It is typically more
concentrated than a random specimen.

• Collection Method: The patient collects the first urine voided after waking up in a clean container.

• Advantages: More concentrated, making it easier to detect abnormalities, such as protein, that may
be present in low concentrations during the day. It provides a more consistent and reliable sample for
certain tests.

• Uses: Pregnancy testing (highly sensitive), protein detection (orthostatic proteinuria), nitrite
detection (UTI screening), microscopic examination for cellular elements and casts (more concentrated).
An ideal sample for detecting Bence Jones protein in suspected cases of multiple myeloma.

3. Midstream Clean-Catch Urine Specimen:

• Description: This is the preferred method for collecting urine for culture and sensitivity testing to
diagnose UTIs. The goal is to minimize contamination of the specimen with bacteria from the external
genitalia.

• Collection Method:
 * The patient is instructed to wash their hands thoroughly with soap and water.

* The genital area is cleaned with antiseptic wipes. Women should separate the labia and clean from
front to back. Men should retract the foreskin (if uncircumcised) and clean the glans penis.

* The patient starts to urinate, allowing a small amount of urine to flow into the toilet (this washes
away contaminants from the urethra).

* Without stopping the flow of urine, the patient collects the midstream portion of the urine in a
sterile container.

* The patient finishes urinating into the toilet.

• Advantages: Minimizes contamination, providing a more accurate representation of the bacteria

• Uses: Urine culture and sensitivity testing for the diagnosis of UTIs.

4. Timed Urine Specimen (e.g., 24-Hour Urine):

• Description: This type of specimen is collected over a specific period, usually 24 hours, to measure
the total amount of a substance excreted in the urine over that time.

• Collection Method:

* The patient is given a large collection container with or without a preservative (depending on the
test).

* The patient is instructed to discard the first urine voided upon waking up. This marks the beginning
of the collection period.

* All subsequent urine is collected in the container for the next 24 hours.

* The final urine specimen is collected at the same time the following morning (the end of the 24-
hour period).

* The collection container must be kept refrigerated or on ice throughout the collection period.

* The total volume of urine is measured and recorded.

• Advantages: Provides a quantitative measurement of the amount of a substance excreted in the

• Uses: Measurement of creatinine clearance (kidney function), protein excretion (proteinuria),

5. Catheterized Urine Specimen:

• Collection Method: A healthcare professional inserts a st

healthcare professional inserts a sterile catheter into the bladder and collects the urine directly into a
sterile container.

* Advantages: Avoids contamination from the external genitalia. Useful for patients who are unable
to urinate voluntarily or who are incontinent.

en when other methods are not feasible.

6. Suprapubic Aspiration:

* Description: This is the most invasive method of urine collection, involving the insertion of a needle
directly into the bladder through the abdominal wall.

* Collection Method: A healthcare professional cleans the skin over the bladder area and inserts a
needle through the skin and into the bladder. Urine is aspirated into a syringe.

* Advantages: Provides the most sterile urine specimen, as it bypasses the urethra entirely.

* Uses: Rarely used, primarily in infants or young children when other methods of collection are
not possible and a sterile urine specimen is essential (e.g., suspected sepsis).

7. Pediatric Urine Collection:

* Description: Collecting urine from infants and young children can be challenging. Several methods
are used:

* Urine Collection Bags: These are adhesive bags with a collection pouch that are attached to the
genital area.

* Clean-Catch Midstream: For older children who can cooperate, the clean-catch midstream
method can be used.

* Catheterization: In some cases, catheterization may be necessary.

* Suprapubic Aspiration: As mentioned above, this is reserved for situations where other methods
are not feasible.

* Collection Method:

* Urine Collection Bags: The genital area is cleaned thoroughly, and the adhesive bag is applied.
The bag is checked frequently and removed as soon as urine is collected.
 * Clean-Catch Midstream: Similar to the adult method, but adapted for children. The parent or
caregiver may need to assist with cleaning the genital area.

* Advantages: Urine collection bags are non-invasive and relatively easy to use.

* Uses: Diagnosis of UTIs in infants and young children.

8. Three-Glass Collection (for Prostatitis Evaluation):

* Description: This method is used to collect three separate urine samples to evaluate for prostatitis
(inflammation of the prostate gland) in men.

* Collection Method:

* First Glass (VB1): The patient collects the first few milliliters of urine voided. This sample
primarily represents urethral bacteria and inflammation.

* Midstream Urine (VB2): The patient collects the midstream portion of the urine. This sample
represents bladder and kidney bacteria and inflammation.

* Expressed Prostatic Secretions (EPS): After VB2, the healthcare provider performs a prostatic
massage to express prostatic secretions into the urethra. The patient then collects the first few milliliters
of urine voided after the massage (VB3). This sample represents prostatic bacteria and inflammation.

* Advantages: Helps to differentiate between urethritis, cystitis, and prostatitis.

references

### **1. General Urinalysis & Specimen Collection**

1. **Clinical and Laboratory Standards Institute (CLSI)**

- CLSI. (2016). *GP16-A6: Urinalysis and Collection, Transportation, and Preservation of Urine
Specimens*.

- **Key Points**: Standard protocols for urine collection methods, including midstream clean-catch
and timed specimens.

2. **Henry’s Clinical Diagnosis and Management by Laboratory Methods**

- McPherson, R. A., & Pincus, M. R. (Eds.). (2022). *Henry’s Clinical Diagnosis* (24th ed.). Elsevier.

- **Key Points**: Comprehensive overview of urinalysis principles, specimen types, and handling.
3. **Harrison’s Principles of Internal Medicine**

- Loscalzo, J., et al. (2022). *Harrison’s Principles of Internal Medicine* (21st ed.). McGraw-Hill.

- **Key Points**: Links urine abnormalities to systemic diseases (e.g., lupus, diabetes, kidney
disorders).

### **2. Urinary Tract Infections (UTIs)**

4. **Infectious Diseases Society of America (IDSA)**

- Hooton, T. M., et al. (2019). *Clinical Practice Guideline for the Management of Asymptomatic
Bacteriuria and Catheter-Associated UTIs*. Clinical Infectious Diseases, 68(10), e83–e110.

- **Key Points**: Validates midstream clean-catch urine as the gold standard for UTI diagnosis.

5. **American Academy of Pediatrics (AAP)**

- Roberts, K. B., et al. (2011). *UTI Diagnosis in Febrile Infants*. Pediatrics, 128(3), 595–610.

- **Key Points**: Supports suprapubic aspiration and catheterization for sterile pediatric urine
collection.

**3. Kidney Disease & Metabolic Disorders**

6. **National Kidney Foundation (NKF)**

- NKF. (2002). *K/DOQI Guidelines for Chronic Kidney Disease*.

- **Key Points**: Recommends 24-hour urine collections for proteinuria and creatinine clearance.

7. **American Diabetes Association (ADA)**

- ADA. (2023). *Standards of Medical Care in Diabetes*. Diabetes Care, 46(Supplement_1).

- **Key Points**: Explains glucosuria screening and limitations of urine tests for diabetes diagnosis.

### **4. Specialized Collection Methods**

8. **Centers for Disease Control and Prevention (CDC)**

- **Key Points**: Sterile techniques for catheterized and suprapubic aspiration specimens.

9. **European Association of Urology (EAU)**

- Bonkat, G., et al. (2023). *EAU Guidelines on Urological Infections*.

- **Key Points**: Validates the three-glass test for prostatitis evaluation.

10. **Journal of Pediatric Urology**

- Schlomer, B. J., et al. (2014). *Urine Collection Methods in Children*. Journal of Pediatric Urology,
10(2), 182–188.

- **Key Points**: Compares accuracy of urine bags vs. catheterization in infants.

### **5. Pregnancy & Drug Testing**

11. **American College of Obstetricians and Gynecologists (ACOG)**

- ACOG. (2020). *Urinary Tract Infections During Pregnancy*.

- **Key Points**: Emphasizes first-morning urine for hCG pregnancy testing.

12. **Substance Abuse and Mental Health Services Administration (SAMHSA)**

- SAMHSA. (2017). *Federal Workplace Drug Testing Guidelines*.

- **Key Points**: Standardizes urine collection protocols for drug screening.

### **6. Research & Advanced Diagnostics**

13. **Journal of Clinical Microbiology**

- Wojno, K. J., & Weinrieb, R. M. (2018). *Urine Cytology for Bladder Cancer Detection*. Journal of
Clinical Microbiology, 56(5), e01319-17.

- **Key Points**: Validates urine cytology for detecting bladder cancer cells.
14. **Clinical Chemistry**

- Delanghe, J. R., & Speeckaert, M. M. (2016). *Preanalytics in Urine Proteomics*. Clinical Chemistry,
62(4), 602–609.

- **Key Points**: Discusses preanalytical factors (e.g., collection timing, preservatives) in urine
research.

(2016). *Urinalysis and collection, transportation, and preservation of urine specimens* (GP16-A6).
Clinical and Laboratory Standards Institute.

- **MLA Style Example**:

Roberts, Kenneth B., et al. “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*, vol. 128, no.
3, 2011, pp. 595–610.