Bladder puncture is required

Abstract

The authors write: “The gold standard for the diagnosis of a urinary tract infection is the detection of the pathogen in the presence of clinical symptoms. The pathogen is detected and identified by urine culture (using midstream urine).” We wish to contradict this statement. Women’s urethras almost always contain pathogens and those of men often do so. Bladder puncture is therefore the only method that will deliver urine that provides a definite result. In 1972 we examined 1013 consecutive patients (192 male, 812 female) in a nephrology outpatient department. UTI were suspected or needed to be ruled out in all of these patients (1). Bladder puncture was undertaken first and then midstream urine was collected. In 192 patients we found a rate of pathogens in excess of 100 000/mL. 30% of those 192 patients had a sterile bladder puncture specimen and would have received unnecessary antibiotic treatment if this limit had been adhered to. For a number of pathogens between 10 000 and 100 000, 61% of bladder puncture specimens were sterile, and for less than 10 000, 87%. In patients with sterile midstream urine (319 patients) the bladder puncture specimen was also sterile. Strictly speaking it is only sterile midstream urine that enables any safe assumptions. In many other cases, varying numbers of healthy patients will be treated and varying numbers of sick patients will not be treated. midstream urine can therefore not be the “gold standard.” Thanks to the availability of ultrasonography, bladder puncture is an easy and safe procedure. It has been described as less painful than venepuncture. The patient has to put up with a certain bladder pressure before the puncture. Considering the amount of work involved for bacteriologists, clinicans should do their best to provide usable specimens. To our knowledge until today the results have neither been corfirmed nor falsified