Fractionated urine samples

In males, although MSUs are adequate, in certain clinical conditions it might be appropriate to take different aliquots of urine to aid localization of the UTI (e.g., diagnosis of prostatitis).

• Voided bladder 1 (VB1)—first 5-10 mL of voided urine and represents urethral flora

• Voided bladder 2 (VB2)—mid-stream urine and best correlates with bladder urine

• Voided bladder 3 (VB3)—initial 2-3 mL of urine, containing expressed prostatic secretions (EPS), collected following prostate massage

In patients with a suspected sexually transmitted infection (STI), urethritis, or urethral discharge, a VB1 and VB3 specimen are sent separately for culture.

• A bacterial count greater than 10 times in VB3 compared to VB1 or 2 is diagnostic of prostatitis

• A leucocyte count >10 per high-power field in VB3 compared to VB1 or 2 is diagnostic of prostatitis

• An EPS or VB3 pH of >8 is suggestive of prostatitis

• A higher bacterial count in VB1 compared to VB3 is diagnostic of urethritis

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