ECBU: fasting, result, how to collect urine?

Many substances can be detected and analyzed in urine. Urinalysis can help in the diagnosis of certain pathologies (urinary tract infection, diabetes…), but also to better define their processing. But they also let you know if a woman is pregnant for example.

What is an ECBU?

We speak of ECBU to designate the CytoBacteriological Examination of Urine. This is surely one of the most requested examinations during consultations. It can detect several compounds that should not be found in urine, or only within certain limits.

• We speak of hemoglobinuria or hematuria when the urine analysis reveals the presence of blood in the urine.
• We are talking about proteinuria when proteins (in greater quantity than the traces usually present) are found there.
• A glycosuria signals the presence of sugars, which may indicate a diabetes.
• As for albuminuriait is a sign of the presence of a particular protein, albumin, and may reflect high blood pressure.
• Other elements (such as sodium, potassium, calcium, chloride, uric acid, urea or the creatinine) can also be searched according to the doctor’s request.
• The presence of white blood cells (called leukocyturia) is relatively common because it signals a urinary tract infection.
• Furthermore, the Beta HCG dosage confirms pregnancy.
• Certain compounds, such as porphyrin, can signal rare diseases.

What are the indications of the ECBU?

The cytobacteriological examination of the urine may be prescribed by the doctor in order to highlight, for example:

• a urinary tract infection,
• cystitis,
• pyelonephritis,
• prostatitis.

In the woman, urinary tract infection is usually manifested by the following symptoms: “pain on urination, such as burning, frequent urination, blood in the urine (which is not necessarily a sign of seriousness, chills or fever“, details the doctor. The same symptoms are found in men, they are sometimes associated with pain in the testicles, as well as a flow of liquid from the urethra.

Do you have to be fasting to do an ECBU?

“The ECBU must be done with the first urine in the morning, or at least after 4 hours without urinating (depending on the laboratories)” replies our interlocutor. Generally, the ECBU is performed when you wake up at home and then dropped off at the laboratory or directly in the laboratory. It is often not necessary to be fasting to perform an ECBU but in doubt , according to the analyzes requested by the doctor, it is better to ask the question to the laboratory before carrying it out.

“There are special conditions for collecting urine, explains Dr. Romain Troalen. It must be done with the first urine in the morning, or at least after 4 hours without urinating (according to the laboratories). It is also necessary to respect hygiene rules, so as not to contaminate the urine with bacteria from the outside.. Urine collection should be done before taking antibiotics.

• Urine collection can be done at home or in the laboratory.
• Wash your hands thoroughly with soap and water or a hydro-alcoholic solution.
• Carry out a meticulous intimate wash with the disinfectant wipe provided (for women: spread the labia majora / for men: wash the glans after removing the cap).
• Open the collection bottle, place the lid with the cannula upwards (Do not touch the blue cannula with your fingers).
• Begin to urinate in the toilet to eliminate the first jet then urinate in the pot without interrupting the jet until a sufficient quantity is reached. (women should hold lips apart during collection).
• The collection vial should not touch the skin.
• Place the bottle.
• Finish urinating normally in the toilet.
• Wash one’s hands.
• Close the bottle with the lid, ensuring a good seal. Bring it back to the lab.

After the collection of the first urine in the laboratory, this examination takes place in two step.

► The first is purely cytological examination, which consists of observing the urine under a microscope in order to detect an abnormally high concentration of leukocytes, cells that multiply in the event of an infection. “If the presence of a urinary tract infection is confirmed, the urine is then cultured, which consists of multiplying the bacteria“, explains Dr. Romain Troalen, general practitioner in the Paris region.

► The bacteriological examination then determines the number and nature of the bacteria responsible for the infection. Depending on the result, the doctor only has to choose the appropriate treatment.

What are the normal results of an ECBU?

Normal values, indicating that there is no pathology, indicate less than 10,000 leukocytes/mL (white blood cells), less than 1,000 red blood cells/mL (red blood cells) and a absence of germ. “There may also be epithelial cells in small numbers. These are the bladder wall protective cells. There may also be hyaline cylinders and crystals”he says.

ECBU positive: what level of leukocytes and red blood cells?

In case of urinary tract infection, the leukocyte and red blood cell counts increases, and one can detect the presence of a bacterium such as, most often, Escherichia coli. “The significant rate of positivity varies according to the laboratories, but it is generally more than 10,000 for leucocytes, red blood cells and bacteria, and more than 1,000 for Escherichia coli”, explains the doctor. Indeed, a high leukocyte level reflects an inflammatory response to an infection. Generally, only one type of bacteria is involved. The laboratory will be able to detect which one thanks to a culture and an antibiogram, and the doctor will give an appropriate treatment.

What is Probe ECBU?

ECBU can be performed in order to prevent a possible urinary tract infection after the placement of a urinary catheter. In this case, the collection of urine is done by introducing a syringe into the tube connecting the bladder to the urinary bag, and not directly into the bag, because there may have been a multiplication of bacteria.

Can an ECBU be made without a prescription?

It is possible to ask to do a urine test without a prescription directly at the laboratory, but you cannot be reimbursed by social security or mutual insurance. You will then be asked to complete a non-prescription test request form. Moreover, in case of infection, it is obligatory to have, thereafter, a medical prescription to obtain a treatment, since antibiotic treatment cannot be obtained without a prescription.

“ECBU in babies works in exactly the same way. The only difference is when collecting the urine: a special bag must be used so as not to contaminate the sample“, explains the doctor. He also recalls that UTIs can be very serious in babies : “They quickly turn into pyelonephritisi.e. kidney infections“. This is a bacterium that travels directly from the bladder to the ureter to arrive in the kidney, which will infect it. “If a child has a fever for three or four days, an ECBU must be performed, because the consequences of pyelonephritis can be very serious“recalls the doctor.

Thanks to Dr Romain Troalen, general practitioner in the Paris region.