Where to get a urine analysis for your UTI
In addition to your primary care physician, GP or secondary consultant offering dipstick and standard mid stream urine tests, the following companies also offer analysis. Each company uses different analysis techniques. These are:
- Mid-stream urine culture (MSU)
- Urinary Broth Culture
- Expanded Quantitative Urine Culture (EQUC)
- PCR (polymerase chain reaction) and/or Next Generation Sequencing
- Microscopy of an immediately fresh urine sample
Providers will answer any questions before submitting a test for analysis. Be aware that that the cost of these analysis methods may not be included in healthcare schemes in your home country and costs can be considerable.
Medichecks UK (mid-stream urine culture)
Medichecks offer a detailed urine culture but only if after an initial culture of 18 hours, markers of infection are found. These include any of the following:
- white blood cells
- bacteria (after 18 hour culture)
- red blood cells
- epithelial cells
If these are determined on initial culture then it will be cultured for longer. Initial notification of the results will be emailed and can be downloaded from their website. Medichecks will also provide antibiotic susceptibilities and resistances to the bacteria found in the sample. The test can be ordered online or over the telephone and there is an option in the online order process to provide a medical history to help the laboratory during analysis. Medichecks have a Customer Service line that can answer any pre and post test questions.
Focus Medical Diagnostics – UK (EQUC/Broth Culture)
UK based, managed and founded by Focus Medical Clinic, Focus Medical Diagnostics offers Extended Quantitative Urine Cultures alongside Liquid Broth Extraction. You are offered a choice of diagnostic options:
(a).direct order without the need for a signed GP authorisation which will provide analysis of your urine culture, bacterial identification and antibiotic sensitivities plus a short clinical recommendation for treatment.
(b).for an additional cost, a signed GP referral which will provide all the services of (a) but will also include a full clinical treatment recommendation in the form of a detailed letter that you can discuss with your GP.
Their specialist, clinical microbiological interpretation will differentiate between commensal bacteria found in the vaginal or urinary tracts and pathogenic, infection causing bacteria.
In addition to test kits for urine analysis, vaginal swab kits can also be ordered for fungal or vaginal infections (note for fungal specification an additional cost is charged).
AIM Laboratories – USA (PCR Testing)
US based and utilising PCR (polymerase chain reaction) for UTI pathogen identification, quantification and detection of antibiotic resistance.
AIM’s UTI solution is one of the fastest available, reporting both pathogen identification and antibiotic resistance testing results within 12 to 24 hours of receiving the patient’s specimen.
A referral from a GP or physician/consultant is needed.
Aperiomics (Next Generation Sequencing testing) – USA
US based, Aperiomics offer deep next-generation sequencing (DNGS) creating a complete genetic fingerprint of microorganisms submitted in a urine sample including species of bacteria, virus, parasites, and fungi.
This service is available to both US and international UTI sufferers. International patients can submit samples without needing to be registered with a doctor but US patients must be registered with a qualified physician before a sample can be submitted.
It is advised by Aperiomics that the report should always be interpreted by a qualified physician and no-one should self-treat following receipt of their test results. The report that is received must be interpreted in context with your symptoms and clinical history. Aperiomics maintain a listing of 600 clinicians they are working with in 18 countries and can provide details.
They also offer support for physicians/patients to enable them to understand the diagnostic report they produce but they will not make treatment or medication recommendations. Please note that at present they are unable to offer antibiotic sensitivities or resistance profiles.
MicroGen DX Laboratory (PCR and Next Generation Sequencing testing) – USA
US based, MicroGen DX use Molecular Diagnostics of PCR and NGS to identify the microbes by extracting the bacterial and fungal DNA within each sample.
A two step process is offered, firstly using PCR analysis against a database of 21 common pathogens and then a more detailed, second level gene analysis is offered. This looks for a specific gene that is common to all bacteria, called 16s ribosomal RNA, and a gene common to all fungi, 18s ribosomal RNA. This genetic material is then compared against their database of micro-organisms.
They also detect antibiotic resistance genes for 10 antibiotic classes and deliver an antibiotic recommendations sheet. Turn around for PCR testing is 24 hours and NGS in 3-5 days.
To submit a sample, patients can choose either the US or International Test Kit option. A referral from a GP or Physician/Consultant is not needed. Test kits can be ordered for urine, vaginal anaerobes or sexually transmitted infections. Individual or combination test options are available and there are gender specific kits available.
MicroGen can also provide a listing of US physicians they are working with to help patients looking for clinical support using their testing. They can also provide interpretation of results for patients and clinicians once the results have been received. However, for international patients when ordering a test, no antibiotic sensitivities/resistances can be provided without the signature of a physician.
Regenerus Laboratories – PCR testing (UK)
Regenerus UK offer the range of Microgen DX UTI laboratory tests for both men and women. Turnaround is 6 days from receipt of the samples. You can order directly from them and receive the results via their online portal. The results provide antibiotic susceptabilities and resistances against each bacteria identified but they do not offer clinical interpretation of the results and are unable to recommend clinicians.
Pathnostics – (PCR testing) – USA
US based, Pathnostics offer a test called Guidance UTI, a unique rapid molecular test for both pathogen identification and antibiotic sensitivity, backed by patented technology. Guidance uses polymerase chain reaction (PCR) to detect DNA from pathogens for UTIs and for prostatitis. Turnaround on receipt of sample and delivery of results in 48 hours.
A referral from a GP or physician/consultant is needed. In addition to test kits for urine analysis, HPV screening for cervical cancer tests can also be ordered.
Pathnostics can also provide a listing of US physicians they are working with to help patients looking for clinical support using their testing. They can also provide interpretation of results for patients and clinicians once the results have been received. They are unable to accept samples from international patients unless they are in treatment with a US practitioner.
Fresh urine microscopy
Fresh urine microscopy testing is only available to NHS patients in treatment at the Lower Urinary Tract Symptoms (LUTS) Clinic at the Whittington Hospital in London or to private patients in treatment with Professor James Malone-Lee and clinicians at their Harley Street practice in London. More about the two clinics on our treatment page.
A sample of fresh urine taken at the clinic is dropped onto a plate for immediate analysis under a microscope.
White blood cells and epithelial cells are counted as markers of an infection.
When infection occurs in the urinary tract, the immune system tries to remove infected cells by shedding the cells in the bladder lining (the epithelium) to be excreted during urination – these are known as epithelial cells.
A high white blood cell count usually indicates that the body is fighting an infection. White blood cells rush in to help destroy the harmful substance and prevent the infection developing further as part of the immune system response to pathogenic bacteria.
The need for immediate analysis of a urine sample is because white blood cells degrade very quickly. Studies have shown this occurs in as little as four hours unless collected in an appropriate sample bottle containing a boric acid preservative. A sample sent for analysis at the laboratory may not identify sufficient or any white blood cells if there is a delay in the delivery and analysis within a four hour period or urine collection does not involve a sample container that utilises boric acid to help preservation.
What to know before submitting a culture
Full instructions as to how to collect the sample, the packaging required and how to mail it will be provided by the relevant laboratory.
Ensure all bladder medications such as antibiotics are stopped for at least seven days prior to providing a sample for testing. The exception to this is if you are providing a sample for fresh urine microscopy where no medications, bladder or otherwise need to be stopped.
If you are using D-Mannose or other natural herbal supplements to treat your infections stop at least 48 hours before testing.
The reasons behind these timings is due to the body life of the antibiotic or supplement taken and how long it resides in the body which will affect test results. Always contact the laboratory or your specialist to discuss medications in advance of testing (with the exception of fresh urine microscopy where this is not applicable), including any medications for other conditions i.e. thyroid, bowel etc. They will be able to advise as to what can be continued and what needs to be stopped and the relevant time-period for cessation.
In all cases, a urinary painkiller such as Azo should be stopped 24 hours before a sample as urine samples will be affected by this medication. Diuretics should also be stopped as well as Vitamin C – all can lead to false negative results.
Try to provide an early morning sample as it will be more concentrated. If this is not possible, limit fluids for around three hours before providing your sample so it isn’t too dilute.
It is recommended that any testing is carried out when experiencing a ‘flare’. This occurs when bacteria are released from the bladder wall cells leading to an increase in symptoms. The greater the concentration of bacteria will lead to more bacterial identification.
Research recently published in the International Urogynaceology Journal has shown that a first stream urine sample rather than mid-stream contains the largest quantity of urinary sediment at the base of the bladder neck due to the effects of gravity and this reduces over the course of the voiding process. You may want to consider providing a sample which catches the first stream to ensure all bacterial, epithelial and white blood cells are included.