Sterile Pyuria

Presence of white cells in urine with negative MSU. Usually not a significant finding.


Indications for referral: 

  • Abnormal USS imaging
  • Risk factor for urothelial TCC (smoking, chemical exposure, etc.) or other concerns may benefit from cystoscopy; suggest a referral letter (not C&B)


Differential diagnosis/Possible causes: 

  • Incomplete treatment of UTI
  • Chlamydia
  • Renal tract stone/foreign body
  • Polycystic kidneys
  • TB
  • Recent instrumentation
  • May be seen with IUCDs


Primary care management prior to referral:

  • Repeat sample to confirm
  • USS renal tract.
  • 3 X Early morning urine if TB diagnosis possible
  • If these tests are normal further investigation is not routinely needed




Mr Christopher Blake, Consultant Urologist, RCHT

Dr Stephanie Jackson, GP Lead Urology


Reviewed: July 2018