Dysuria is a common presenting complaint of women and urinalysis is a valuable tool in the initial evaluation of this
presentation. Clinicians need to be aware that pyuria is the best determinate of bacteriuria requiring therapy and
that values significant for infection differ depending on the method of analysis. A hemocytometer yields a value of
≥ 10 WBC/ mm3
significant for bacteriuria, while manual microscopy studies show ≥ 8 WBC/high-power field
reliably predicts a positive urine culture. In cases of uncomplicated symptomatic urinary tract infection, a positive
value for nitrites and leukocyte esterase by urine dipstick can be treated without the need for a urine culture. Automated
urinalysis used widely in large volume laboratories provides more sensitive detection of leukocytes and
bacteria in the urine.With automated microscopy, a value of > 2 WBC/hpf is significant pyuria indicative of inflammation
of the urinary tract. In complicated cases such as pregnancy, recurrent infection or renal involvement,
further evaluation is necessary including manual microscopy and urine culture with sensitivities.
