URINE, CULTURE, SEGMENTED, AEROBIC BACTERIA - (U)
Test Code: UCM, CU, MU, SPU, SPAN, URSW, URVC
A segmented urine sample (also referred to as the Meares–Stamey 4-Glass Urine Test) is indicated in the investigation of patients with symptoms and/or signs suggestive of chronic bacterial prostatitis. It assists with localization of infection to the prostate. Traditionally, this test has been performed by collecting four separate samples: 1) the first 10 mL of voided urine (VB1, urethral specimen), 2) a midstream urine (VB2, bladder specimen), 3) expressed prostatic secretions (EPS) obtained by prostate massage, and 4) the first 10 mL of voided urine after prostate massage (VB3, prostate specimen). However, there are several variations of this test (e.g., two-glass test where only the VB2 and VB3 specimens are obtained).
A diagnosis of chronic bacterial prostatitis is supported by finding a pathogen only on culture of the prostatic specimens (EPS and/or VB3) or finding a pathogen in the prostatic specimens that is at least 10 times higher than in the urethral (VB1) and bladder (VB2) specimens. Note that it may be difficult to interpret the test if the colony count in the VB2 specimen is ≥10^6 cfu/L, as bladder bacteriuria may mask the frequently small number of ogranisms from the prostate.
A segmented urine sample is indicated in the investigation of patients with symptoms and/or signs compatible with chronic bacterial prostatitis. A prostate massage should NOT be performed in patients presenting with a clinical diagnosis of acute bacterial prostatitis.
Patient Preparation Instructions:
When collecting the specimens, the patient should start by thoroughly washing their hands with soap and water. The foreskin should be retracted (if uncircumcised) when voiding. The first 10 mL of voided urine (VB1) should be collected in sterile specimen container. A 10 mL midstream urine sample (VB2) should be collected in a sterile specimen container after the patient has voided approximately 100 to 150 mL of urine. The physician then performs a prostate massage for approximately 1 minute and expressed prostatic secretions (EPS) are collected in a sterile specimen container. The expressed prostatic secretions should emerge from the urethra within two to three minutes of the prostate massage. Finally, the first 10 mL of urine (VB3) following prostate massage should be collected in a sterile specimen container.
The urine samples (VB1, VB2, and VB3) may be submitted in their sterile specimen containers or transferred to BD Vacutainer Urine Collection Devices. The EPS specimen should be submitted in a sterile specimen container (do NOT transfer to a BD Vacutainer Urine Collection Device). If a BD Vacutainer Urine Collection Device is used for the urine samples, follow the manufacturer’s recommendations on how to fill the tube.
Accurate patient identification must be made prior to sample collection. Patient identification should be done in accordance with site policy.
Samples and requisitions must be labeled/completed in accordance with the Shared Health Specimen Acceptance Policy. Be sure to clearly indicate which specimen containers correspond to the VB1, VB2, EPS, and VB3 samples.
Sterile Specimen Container (100 mL) OR BD Vacutainer Urine Collection Device. Note that the EPS sample must be submitted in a sterile specimen container.
Sterile Specimen Container: ≥1 mL in each of the four containers.
BD Vacutainer Urine Collection Device (for VB1, VB2, and VB3 specimens): Minimum 3 mL as indicated by minimum draw line on tube.
A descriptive report will be sent. Significant uropathogens recovered at a quantity of ≥10^5 cfu/L will be identified and susceptibility testing for these isolates will be performed.
If no bacteria are recovered at ≥10^5 cfu/L a report of "No growth at 10^5 cfu/L." will be issued by the microbiology laboratory.
The anticipated turn-around-time is two to three days from receipt of the specimen in the Microbiology laboratory.
Local - Unpreserved: ≤2 hrs at room temperature, ≤24 hours at 4°C. Preserved: follow manufacturer's recommendations.
Courier/local storage - Unpreserved: ≤24 hours at 4°C. Preserved: follow manufacturer's recommendations.
Ensure samples that are being sent to a referral laboratory are packaged in accordance with Transport of Dangerous Goods recommendations for diagnostic samples.