Cancer Diagnosis Program | Biorepositories and Biospecimen Research Branch

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Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men?

Author(s): Lipsky BA, Inui TS, Plorde JJ, Berger RE

Publication: Am J Med, 1984, Vol. 76, Page 257-62

PubMed ID: 6695949 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study investigated the effects of meatal cleaning, midstream sampling, and circumcision status on bacterial growth and urine contamination. Three-hundred eight matched initial and mid-stream urine specimens were collected from 254 men at a urology clinic with no exclusions. Of the matched specimens, 142 came from circumcised men and 166 from uncircumcised men. Men with an even social security number were told to clean the glans with a Betadine pad while those with odd numbers were not instructed to clean. After collection, specimens were refrigerated for less than 4 h before transport to the laboratory where gram-stained smears were examined microscopically and cultures were inoculated. A positive culture was defined as 10⁴ cfu/mL of a single or predominant (90% of growth) organism, an indeterminate culture was defined as 10³ cfu/mL of a single or predominant organism, and a contaminated culture was defined as a culture with 10³cfu/mL or more of two or more organisms. Any culture with less than 10³cfu/mL was considered negative.

   Summary of Findings:

   Positive cultures occurred at similar rates in mid-stream and initial urine (7.8% versus 7.1%), urine obtained with or without cleaning (8.9% versus 6.0%), and urine from circumcised and uncircumcised men (8.1% versus 6.9%). However, there was a significantly higher rate of positive culture in circumcised rather than uncircumcised men (12.3 percent versus 6.0 percent, P = 0.05) when analysis was limited to only patients who cleansed. Contamination rates were not significantly different in urine obtained with or without cleaning (8.6% versus 12.9%) and urine from circumcised and uncircumcised men (9.2% versus 12%), but were higher in initial than mid-stream urine (8.4% versus 13%, P<0.002). The majority of positive specimens were positive in both the initial and mid-stream specimen (44 of 46, 96%) and the majority of negative specimens were negative in the matched specimen (392 of 494, 79%), but only 40% (4 of 10) of the indeterminate specimens were indeterminate in the matched specimen. 

   Biospecimens

   • Bodily Fluid - Urine

   Preservative Types

   • Other Preservative

   Diagnoses:

   • Not specified

   Platform:

   Analyte	Technology Platform
   Cell count/volume	Light microscopy
   Cell count/volume	Microbiological assay

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Method of fluid acquisition	Different urine collection procedures compared Collection site preparation methods compared
   Preaquisition	Diagnosis/ patient condition	Circumcised Uncircumcised

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