Sterile pyuria: General ideas and proper managements

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Sterile pyuria is another common consultation in my Urology office. This condition always frustrated the patients as well as doctors while encountered this problem. Before the discussion on the etiology, we shall have known clearer on its definition first.

Sterile pyuria is a combination words between “sterile” and “pyuria”

• Sterile – means no bacterial infection in that urine specimen
  • The method to be confirmed is a urine culturing
• Pyuria – means positive inflammation cells in a simple urine examination testing
  • Normally we consider more than 2 WBC/HPF or white blood cells per high power field as a positive test

Then the “Sterile pyuria” is meant a state of positive inflammation cells in urine without bacterial infection. Next question is why this phenomenon happens? I will divide into 2 major causes

2 Major causes of Sterile pyuria

1. Infectious-related cause
   • For one who have bacterial infection but currently or recently just had antibiotic therapy within 2 weeks – the antibiotic‘s effects have interrupted the result of the urine culture which called a “False negative” urine culture result.
   • Patient suffered from other kind of infections which is not a bacterial organism for example – Parasite, viral or tuberculosis infections.

2. Non-infectious-related cause – Need clinical clues as the following examples.
   • Significantly weight loss – Could possibly a urinary tract malignancy
   • Previously have done urologic procedures or pelvic radiation – Could possibly a normal inflammatory reaction
   • Urine examination test also report a positive red blood cells – Could possibly a urinary tract stone or kidney parenchymal disease
   • Patient has other systemic conditions – Pregnancy, diabetes, severe hypertension, post-menopausal state, systemic lupus erythematosus (SLE) or bladder pain syndrome
   • Patient is currently on a specific medications – Anti-inflammatory drug (NSAID), steroids, penicillin or anti-stomach upset tablets (Proton pump inhibitors)

After we know the possibly root cause, then we do a proper investigations and treatments follow by our assumption. On the other hand, if the cause of sterile pyuria is not harmful so, we will advocate patient to go on the observation and follow a regular urine examination checkup.

That is all about the general idea of sterile pyuria management. If you have any questions, please talk to your trusted urologist or it would be my pleasure if you text me. See you in the next article!

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