The urinary tract consists of:

the kidneys
the ureters
the bladder
the urethra
The anatomy of the female urethra
is of particular importance to the
pathogenesis of UTIs.

The female urethra is

relatively short
compared with the
male urethra
 lies in close proximity
to the warm, moist,
perirectal region,
which is teeming with
microorganisms.
Because of the shorter urethra,
bacteria can reach the bladder more
easily in the female host
Apart from the distal urethra, the
urinary tract in health should be sterile.

Resident Microflora
of the Urethra
CNS( excluding S. saprophyticus)
Viridans & non-hemolytic streptococci
Lactobacilli
Diphtheroids
Nonpathogenic Neisseria spp.
Anaerobic cocci & bacilli
Commensal Mycobacterium spp.
Commensal Mycoplasma spp.
INFECTIONS OF THE URINARY TRACT

The urinary tract is one of the

commonest sites of bacterial
infections, and considerable time and
effort go into their diagnosis.
UTIs are most often caused by a
single bacterial pathogen
Frequently originating in the
patient's commensal enteric or skin
flora.
They range from the
relatively trivial
symptoms of cystitis
through to potentially
life-threatening
infections affecting
the kidney.
Bacteria ascending
through the
urethra to the
bladder cause the
majority of urinary
tract infections.
From here, bacteria
may reach the
kidney to cause
pyelonephritis,
although in a
minority of cases,
bacteria may reach
the kidney via the
bloodstream.
 others
Clinical Specimens urine specimens
 Prevention of contamination by
normal vaginal, perineal, & anterior
urethral flora is the most
important consideration for
collection of clinically relevant urine
specimen.
 Failure to do so may result in a
report of "multiple organisms'
present suggesting contamination."
1. Timing:

 It is best to obtain early morning

specimens whenever possible
 or specimens that had remained in
the bladder for 4 hours.
2. Container:

 It is the responsibility of the

laboratory to provide the patient
with sterile, wide-mouthed glass or
plastic, jars, beakers or other
suitable receptacles that should
have tight-fitting lids.
2. Container:

 avoid contamination with menstrual

blood, vaginal secretions, and
feces.
3. Urine collection:

 Clean-catch midstream (CCM) 

 Suprapubic aspiration 
 Catheterization
 Indwelling catheter
a) Clean-Catch Midstream:

 The best sample for a routine

urinalysis is a clean-catch
midstream sample collected after
the external genitalia have been
cleansed.
a) Clean-Catch Midstream:

 The external
genitalia must be
washed properly.
a) Clean-Catch Midstream:

 The first portion of

urine is voided to wash
out any microbes from
the distal part of the
urinary tract.
a) Clean-Catch Midstream:

 It is the middle
section of the
urinary flow that is
collected for
laboratory analysis.
In males:

The glans penis should be cleansed

using cotton moistened with sterile
saline.
The patient is instructed to void
discarding the first portion of the
void, collecting the middle part and
discarding the final portion.
In females:

The female patient is instructed to

separate the labia and wash the
urethral orifice with several single
downward strokes using sterile
moistened cotton and then collect
the urine with the labia still
separated.