Great question about the urine.
When they do urine tests, they do basically two tests:
1. Urinalysis or U/A. This looks at specific gravity, white blood cells, casts, sometimes drugs, any other chemicals or characteristics of urine itself that should or shouldn't be there. For this test, urine can be taken directly out of the spout.
2. Culture and Sensativity. This tests for the presence of bacteria in the urine and what antibiotics are appropriate for treatment.
a. The best way to get a sample for a culture is to have someone who is trained (like me) to remove the pouch, clean the stoma with betadine and insert a small catheter into the stoma to get a sample. That takes about 20 minutes to get a good sample. It's not done in the ED much because people are scared about doing it, don't know how or simply don't realize it's important to do it that way.
b. An "ok" method is to remove the pouch, clean the skin and stoma well, put a new pouch on and take urine from the bag as soon as there is enough in it. This is not sterile, but will give a fairly good idea of what bugs are present that probably are causing an infection.
c. Taking urine from an old pouch isn't a really good idea. First, since the intestine used for creation of the stoma produces mucus all the time, people look at it and assume that there is an infection because it looks bad (if it were from the bladder). But that's normal forhim to have mucus, so that's an error. Also, after a few hours, even with generally good technique and clean supplies, bacteria starts to grow that was introduced from the environment. A urine bag is a great place to grow bugs, normally not causing any problems, but just colonizing a bag. But, with a urine sample, if it were compared with people that have bladders, it would be bad. Just a normal finding with a urostomy.
So, in a nutshell, there's no clear way to tell from the test whether a urinary tract infection is actually present. If there are symptoms that continue or pain in the kidneys, much increased mucus, blood in the urine or fevers that don't go away occur, then those are much better indications of a UTI.
