Table 4.

Urine specimen collection method

	Urine bag	Clean catch (CCU/MSU)	Catheterization (CSU)	SPA
Description	After carful cleaning, an adhesive plastic bag is applied to collect urine	The MSU is collected twice after simple retraction of the prepuce in uncircumcised male infants and simple separation of labia majora in female children	After disinfection of the periurethral area, catheter is inserted to catch the urine	After disinfection of suprapubic area and under ultrasound guidance, the urine is aspirated by perpendicular midline puncture with 21-gauge needle, 1 cm above the symphysis pubis
Indications	Unable to collect urine by other methods	Toilet-trained children Parenteral concern regarding CSU and SPA collections	Non toilet-trained infant Acute urinary retention	Nontoilet-trained infant Uncircumcised boys with redundant foreskin or phimosis Girls with labial adhesions Periurethral irritation
Contamination	Highest rate of contamination False positive rate 88%–99%	Greater risk of contamination than catheterization	Potential risk of contamination	Rare
UTI diagnosis	High contamination rate Not suitable to diagnose a UTI	>105 CFU/mL clinically relevant organisms+pyuria/bacteriuria		Any growth of clinically relevant organisms+pyuria/bacteriuria
Benefits	Noninvasive techniques Negative culture tests may exclude a UTI	Noninvasive technique Preferred technique for children who are able to void on request	Less painful and less invasive than SPA	Preferred aseptic method Less likely to acquire contamination

UTI: Urinary tract infection, MSU: Midstream urine, CCU: Clean catch urine, CSU: Catheter specimens of urine, SPA: Suprapubic aspiration, CFU: Colony-forming unit