The video version of this podcast can be found here:· https://youtu.be/ivCRpRFs3cgFor the non-visible haematuria video:· https://youtu.be/SaizjWg7FngFor the non-visible haematuria podcast: · https://youtu.be/bIKhn43o7ZI My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I go through the interpretation and initial management of sterile pyuria, always focusing on what is relevant in Primary Care only. The information is based on based on published medical articles in the British Journal of General Practice as well as the New England Journal of Medicine. The link to them can be found below. Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by any of the institutions.I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the information consulted. You must always use your clinical judgement. There is a YouTube version of this and other videos that you can access here: · The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The resources consulted can be found here:Sterile pyuria: a practical management guide - British Journal of General Practice 2016; 66 (644): e225-e227:· https://bjgp.org/content/66/644/e225Sterile Pyuria – Review article NEJM - N Engl J Med 2015; 372:1048-1054:· https://www.nejm.org/doi/10.1056/NEJMra1410052?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.govThe non-visible haematuria video can be found here:· https://youtu.be/SaizjWg7FngThe non-visible haematuria podcast can be found here: · https://youtu.be/bIKhn43o7ZI Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I’m Fernando, a GP in the UK. Today we are going to go through the interpretation and initial management of sterile pyuria, always focusing on what is relevant in Primary Care only. The information is based on two relevant medical publications in the British Journal of General Practice as well as the New England Journal of Medicine. The links to them are in the episode description. If you want a reminder on how to manage non-visible haematuria, please watch the corresponding episode on this channel. The link is in the episode description too. Right, so let’s jump into it. Sterile pyuria is not an uncommon finding in clinical practice. Nine per cent of patients with lower urinary symptoms, and who are suspected of a UTI, are found to have sterile pyuria. It can be higher in specific populations and sterile pyuria is more common among women because of the higher incidence of pelvic infection. Sterile pyuria continues to pose a diagnostic conundrum because there are no guidelines on its management. Furthermore, no agreed definition for sterile pyuria exists. It is simply the presence of white blood cells in the urine, in the absence of infection. Some authors have defined it as the presence of 10 or more white cells per cubic millimetre of urine, 3 or more white cells per field on microscopy, or a urinary dipstick test that is positive for leucocytes, all of this in the absence of positive urine cultures. Sterile pyuria can also be associated with haematuria, proteinuria, and casts, complicating the diagnosis. (Causes) Looking at the cause, broadly speaking, sterile pyuria may be classified as infectious or non-infectious. Let’s look at the infectious causes first. Simple bacterial UTIs are extremely common. However, a recently treated UTI, usually within 2 weeks, or even after a single dose of antibiotics, can present as sterile pyuria. Therefore, we should check whether a recent course of antibiotics has been given and, if we are treating a UTI and requesting a urine culture, we should ensure that we advise patients to collect the urine sample before taking the first dose of antibiotics. When considering UTIs, we also need to take into account that, although colony counts greater than 100,000 colony-forming units per millilitre of urine (CFU/ml) have historically been used to diagnose a UTI, bacterial colony counts as low as 1000 colony-forming units per millilitre (CFU/ml) can be a sign of bacteriuria. So, it is important to consider that lower bacterial counts can still be associated with a urinary tract infection, even though the urine culture may be reported as negative, so ...
