Pyuria, leucocyturia (WBC in the urine)
Pyuria is the presence of leukocytes in the urine, a sign of infectious and inflammatory diseases of the kidneys and urinary tract. In normal urine, leukocytes are found in numbers from 0 to 5 in the field of view if there is an appropriate toilet.
Leukocyturia is often neutrophilic. It is found when:
- acute and chronic pyelonephritis, pyelitis, cystitis, urethritis
- polyps and malignant tumors of the bladder or pelvis
- kidney tuberculosis
- kidney abscess or abscess breakthrough from surrounding tissue
- medicinal nephropathies
- infections caused by various pathogens (Trichomonas, Gonococcus, Mycoplasma, viruses, Fungi)
Leukocyturia (pyuria), however, is not always combined with bacteriuria, and the absence of leukocyturia does not exclude the need for bacteriological examination.
In early childhood, the high sensitivity of the kidneys allows them to respond to the mildest diseases with leukocyturia (pyuria). In the elderly, a certain functional inertness of the kidneys and intestinal atony contributes to the occurrence of an infection of the urinary system.
It is especially difficult to recognize pyelonephritis against the background of prostate adenoma and prostatitis.
Lymphocyturia is found in infectious-allergic (immune) diseases, in which eosinophilia can also be detected.
The simultaneous detection of leukocytes and squamous epithelial cells is characteristic of lesions of the lower urinary tract. The presence of urethral filaments and leukocytes indicates inflammation of the urethra.
For topical diagnosis of leukocyturia (pyuria) in urological practice, a two- and three-glass test is used. The patient is invited to urinate in two vessels. The initial portion in a volume of 50-60 ml is collected in the first vessel, the rest in the second. The degree of turbidity and color intensity of urine in the vessels is determined by the eye, followed by microscopy of urinary sediments. In the third sample, the residual urine is collected after prostate massage.
- clouding and leukocytes in the first glass (initial pyuria) indicate an inflammatory process in the urethra, which is observed with urethritis
- opacity and leukocytes in the second glass (terminal pyuria) confirm damage to the prostate or seminal vesicles
- in the presence of pus in all portions (total pyuria), one can think of an inflammatory process in the bladder, pelvis, and kidneys (cystitis, pyelonephritis)
The simultaneous detection of leukocyte and granular casts indicates a renal origin of leukocyturia.
A three-glass test reveals the source of pyuria in the prostate gland if changes take place in the third portion. In this case, pus enters the urine at the end of the act of urination, with the contraction of the pelvic floor muscles and the emptying of the prostate gland.