At the Academy Awards in February, some big Hollywood stars are going to receive a novel urine collection device in their Oscars gift bags. Yes, you read that correctly. The modified urine cups are going into the gift bags of this year's 25 acting and directing nominees. The device, a modified plastic cone that captures only the middle of the urine stream in a standard 10- or 30-mL tube, is called the Peezy Midstream. It is claimed to fix many of the problems with urinary tract infection (UTI) testing. But physicians say the research behind the device may not yet have caught up with the promotion. Existing urinary collection methods are messy and don't guarantee that a patient will provide an uncontaminated midstream sample, said Giovanna Forte, CEO of Forte Medical, the UK-based company behind the device. Forte's physician brother invented the Peezy Midstream as a simple diagnostic tool that would provide a clean sample for a more accurate diagnostic test. An uncontaminated sample would aid physicians in making better and more targeted UTI treatment decisions, Forte said. Without that clean sample, providers may have to reorder tests, or they may receive inaccurate results that lead to improper treatment, delayed treatment, or the prescribing of unnecessary antibiotics, argues Forte. "We're a teeny tiny company and we're highlighting this massively overlooked, hidden problem in healthcare that's very basic," she said. Not all physicians are convinced this problem is as widespread as Forte claims. "Medically speaking, I'm not convinced we have the problem that's being cited, nor is this device the answer to the purported problem being cited by the manufacturer," said Richard Colgan, MD, professor in the Department of Family and Community Medicine at the University of Maryland School of Medicine in Baltimore. Although contaminated urine samples can cause inconclusive or confusing results during UTI testing, it's not a problem for most patients, said Kenneth Lin, MD, a family medicine physician and associate professor at Georgetown University School of Medicine, Washington, DC. "If a cultured urine sample grows a single predominant organism, that's overwhelmingly likely to be the bacterial infection that needs to be treated," he said. Besides, typical UTIs are often diagnosed on the basis of symptoms alone, particularly if the patient has had one before, Lin said. He noted that in many cases, he can prescribe one of two antibiotics that cover the common bacteria behind UTIs without the need of a culture. When it comes to addressing the issue of overprescribed antibiotics and antibiotic immunity, Colgan isn't convinced this device is the answer. Instead, clinicians should follow guidelines issued by groups such as the Infectious Disease Society of America (IDSA), he said. (Colgan was involved in the IDSA recommendations on asymptomatic bacteriuria.) In certain situations, overuse of a device such as this could lead to overdiagnosis. Lin said he could see this primarily as a problem in nursing homes, where testing the urine of an elderly patient who has not presented with UTI symptoms can lead to unnecessary treatment. That said, the simple device may provide a better experience for patients, Colgan said. And the collecting of purely midstream urine is certainly desirable for a UTI test, he added. The Peezy Midstream already has some traction in the United Kingdom, and Forte hopes publicity about the Oscar gift bag inclusion could create more patient awareness of this form of testing. The device could be especially useful for elderly women and women who are pregnant, Lin said. Both populations struggle with the traditional pee-in-a-cup method, which can lead to highly contaminated samples. Plus, pregnant women are one of just two patient groups who are treated for asymptomatic bacteria, making these samples all the more important. (The other group consists of patients who need an endo-urologic procedure where there is the potential for bleeding to occur, Colgan said.) More research needs to be done about the effectiveness of the device, specifically in pregnant and elderly women, Lin said. "I think they would be the main customers." Initial research suggests the device could help. A urinalysis audit conducted by a patient safety midwife with the West Hertfordshire National Health Service Trust in England found that the Peezy Midstream reduced the number of false positives and the number of repeated tests for the pregnant women who were tested. Overall, physicians interested in the device should know that it has potential but needs more research, Lin said. "There needs to be more study to see if it works in these particular situations where you need a good urine culture," he said. "The promotion may have gotten a little ahead of the evidence." Source
