From the Guidelines
Laboratory tests for an irritated bladder should include urinalysis and urine culture, with the minimum laboratory evaluation consisting of urinalysis for determination of leukocyte esterase and nitrite level by use of a dipstick and a microscopic examination for WBCs, as recommended by the Infectious Diseases Society of America 1. When evaluating a patient with suspected urinary tract infection (UTI), it is essential to consider the presence of symptoms such as fever, dysuria, gross hematuria, new or worsening urinary incontinence, and/or suspected bacteremia. The following laboratory tests are indicated:
- Urinalysis to examine the urine for signs of infection, blood, or abnormal cells
- Urine culture to identify specific bacteria if an infection is present
- Microscopic examination for WBCs to confirm the presence of pyuria
- Leukocyte esterase and nitrite level testing using a dipstick to support the diagnosis of UTI According to the American Urological Association, the basic laboratory testing for interstitial cystitis/bladder pain syndrome should include urinalysis and urine culture, with additional tests such as urine cytology if the patient has a history of smoking or presents with unevaluated microhematuria 1. It is crucial to note that the choice of laboratory tests may vary depending on the patient's symptoms, medical history, and the presence of underlying conditions. In general, the goal of laboratory testing is to determine the underlying cause of the irritated bladder, whether it be infection, inflammation, or other conditions, and to guide appropriate treatment. For example, if urosepsis is suspected, urine and paired blood specimens should be obtained for culture and antimicrobial susceptibility testing, and a Gram stain of uncentrifuged urine should be requested 1.
From the Research
Laboratory Tests for Irritated Bladder (Cystitis)
The following laboratory tests are indicated for an irritated bladder (cystitis):
- Urinalysis to rule out underlying infection or other concerning potential etiologies 2, 3, 4
- Urine culture to detect pathogens in urine 5, 6
- Microscopic examination of urine to detect white blood cells (WBC) and bacteria 5
- Assessment of post-void residual urine to evaluate urinary retention 3
- Comprehensive urodynamic testing, endoscopic evaluation of the lower urinary tract, imaging of the upper urinary tract, neurologic evaluation, or spine imaging may be considered in certain situations, such as refractory cases or significant neurological disease 3
Specific Testing Situations
Additional testing may be recommended in the following situations: