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Introduction: There is a relationship between excess body weight and the risk of a number of infectious diseases, including urinary tract infections (UTIs). This study aimed to investigate the correlation between body mass index (BMI) and UTIs among Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study (PGCS) population. Methods: This cross‐sectional study was conducted on 10,520 individuals aged 35–70 years from PGCS. The demographical data and clinical characteristics of the participants were recorded. Microscopic examination of the urine samples was performed to detect the presence of bacteria or white blood cells (WBC) as indicators of infection. UTI was defined as the presence of bacteria in the urine (Few, moderate, and many) and a value of ≥10 WBC/high power field (HPF) by light microscopy. Results: The prevalence of UTIs in this study was 8.8%, with a higher incidence in females compared to males (12.2% vs. 4.7%, p < 0.001). Among participants, the prevalence of UTIs across different weight categories was as follows: underweight/normal weight, 7.1%; overweight, 8.1%; and obesity, 10.9%. According to the unadjusted model, subjects with obesity were at significantly higher odds for UTIs than subjects with underweight/normal BMI (OR = 1.62, 95% CI: 1.35–1.93, p < 0.001). However, this association was no longer significant after adjusting for demographic and clinical variables. Conclusion: The findings of this study provide evidence supporting a higher prevalence of UTIs among individuals with obesity. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether antibiotics impact delirium outcomes in older adults with pyuria or bacteriuria in the absence of systemic signs of infection or genitourinary symptoms. Methods: We registered our systematic review protocol with PROSPERO (CRD42023418091). We searched the Medline and Embase databases from inception until April 2023 for studies investigating the impact of antimicrobial treatment on the duration and severity of delirium in older adults (≥60 years) with pyuria (white blood cells detected on urinalysis or dipstick) or bacteriuria (bacteria growing on urine culture) and without systemic signs of infection (temperature > 37.9C [>100.2F] or 1.5C [2.4F] increase above baseline temperature, and/or hemodynamic instability) or genitourinary symptoms (acute dysuria or new/worsening urinary symptoms). Two reviewers independently screened search results, abstracted data, and appraised the risk of bias. Full‐text randomized controlled trials (RCTs) and observational study designs were included without restriction on study language, duration, or year of publication. Results: We screened 984 citations and included 4 studies comprising 652 older adults (mean age was 84.6 years and 63.5% were women). The four studies were published between 1996 and 2022, and included one RCT, two prospective observational cohort studies, and one retrospective chart review. None of the four studies demonstrated a significant effect of antibiotics on delirium outcomes, with two studies reported a worsening of outcomes among adults who received antibiotics. The three observational studies included had a moderate or serious overall risk of bias, while the one RCT had a high overall risk of bias. Conclusions: Our systematic review found no evidence that treatment with antibiotics is associated with improved delirium outcomes in older adults with pyuria or bacteriuria and without systemic signs of infection or genitourinary symptoms. Overall, the evidence was limited, largely observational, and had substantial risk of bias. [ABSTRACT FROM AUTHOR]

Background: Little information is currently available about the analytical variability of urinalysis. Objective: We aimed to compare results obtained by two operators using six microscopic methods in the quantification of urinary leukocytes (WBC) and erythrocytes (RBC). Methods: Forty urine samples (10 mL) were centrifuged (450g, 5 minutes) and resuspended in 0.5 mL of supernatant. Two operators with different expertise in urinalysis interpreted sediment results using the six methods, obtained by combining the use of microscope slides (Slide) or counting chambers (Chamber) with three different techniques: bright‐field (BF) microscopy, phase‐contrast (PC) microscopy, and stained sediment (SS) evaluations. The mean WBC and RBC counts from 10 fields (Slide) or squares (Chamber) observed at 400× were used to calculate the difference and agreement between operators and methods. We also estimated the concordance between methods in classifying microhematuric or pyuric samples. Results: Operator 2 counted significantly lower WBC counts using Slide+BF (P = 0.009) and Slide+PC (P = 0.001) than Operator 1, whereas no inter‐operator differences were recorded for RBC counts. The concordance between the operators ranged from "good" to "very good." No differences or biases were found for WBC counts among the methods, and concordances were "good" to "very good"; proportional biases were found for RBC counts between Slide+BF vs Slide+SS and Slide+PC vs Slide+SS. Concordance measurements for RBC counts ranged from "good" to "very good." Conclusions: All methods yielded good reproducibility among operators, although stained SS evaluations allowed better identification of WBC by the inexperienced operator. However, we suspected that the SS preparations affected RBC counts. All other methods yielded reproducible WBC and RBC counts. [ABSTRACT FROM AUTHOR]

Background: The IDEXX SediVue Dx (SediVue) is an automated, in‐clinic urine sediment analyzer for veterinary patients. The bias between the results from manual microscopy and the SediVue is currently unknown. Objectives: To assess the diagnostic accuracy of the SediVue, we aimed to determine the bias between the SediVue (index test) and manual microscopy (reference standard) for the quantification of RBCs and WBCs in urine. Methods: Urine remnant samples were collected from cats and dogs that contained RBCs (n = 462) and WBCs (n = 510). Retrospective analysis of results from urine sediment examinations using both manual microscopy (using a KOVA and DeciSlide system) and the SediVue (1.0.1.3) was performed. Bias was determined with Bland‐Altman plots. SediVue‐captured images from high‐bias samples were reviewed, and biases were compared. Results: The median bias for semi‐quantitative RBC and WBC counts was determined for RBC and WBC counts. The cutoffs were RBC ≤ 5/HPF, 0.3; RBC 5.1‐10/HPF, 10.1; RBC 10.1‐20/HPF, 10.6; and RBC > 20/HPF, 28.93; WBC ≤ 5/HPF, 0.1; WBC 5.1‐10/HPF, 2.2; WBC 10.1‐20/HPF, 9.4; and WBC > 20/HPF, 26.6. High bias between the methods was identified in 98 samples (21.0%) with RBCs and 77 samples (15.7%) with WBCs. Reviewer‐based enumeration of the SediVue‐captured images decreased the percentage of samples with high bias to 17.3% for RBCs and to 11.4% for WBCs. Conclusions: Bias in the RBC and WBC counts between manual microscopy and the SediVue was unlikely to impact clinical interpretations in a majority of cases. Although reviewer enumeration of SediVue‐captured images reduced observed bias, inherent differences between methodologies appeared to have a larger impact on the bias. [ABSTRACT FROM AUTHOR]

Background: Urinalysis (UA) is often used to screen for bacterial cystitis, regardless of sediment results, and followed up by quantitative urine culture (UC) for definitive diagnosis. Objectives: Determine prevalence of positive UCs in dogs with inactive urine sediments on routine UA. Animals: A total of 1049 urine samples with inactive urine sediments and UCs collected from dogs presented to a veterinary specialty hospital between January 2018 and February 2020. Methods: Retrospective study of dogs with an inactive urine sediment on routine UA and follow‐up UCs. Signalment, UA findings, proteinuria, and UC results were recorded. Associations among these findings were assessed using multivariate logistic regression carried out using a backward stepwise method. Results: Overall prevalence of positive UC was 3.4% (95% confidence interval [CI], 2.4‐4.8). Escherichia coli was the most commonly isolated bacteria. Only naturally voided samples were associated with increased prevalence of positive culture when compared to collection by cystocentesis or a non‐specified method. No statistically significant association with culture positivity was found for urine protein‐to‐creatinine ratio, urine specific gravity, urine pH, breed, age, or sex. Conclusions and Clinical Importance: Based on the low prevalence (3.4%) of positive culture in urine samples from dogs with inactive sediment on routine UA and the relatively high cost of UC and sensitivity, cost‐benefit analysis including clinical suspicion of lower urinary tract disease should inform testing decisions, rather than routinely performing cultures on urine samples without active sediments. [ABSTRACT FROM AUTHOR]

An 8‐month‐old Vietnamese pot‐bellied boar was presented with a 3‐week history of constipation and an enlarged scrotum. Abdominal and scrotal ultrasonography was performed to assess the gastrointestinal and genitourinary tracts. An obstructive gastrointestinal lesion was ruled out, although a large cavitated heterogeneous mass was identified dorsal to the body of the bladder, which was consistent with the location of the seminal vesicles. Culture of a sample of preputial discharge revealed growth of four bacterial types, including Escherichia coli and Trueperella abortisuis. Given the clinical findings, a diagnosis of seminal vesiculitis was made and antimicrobial therapy was initiated. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between residual urine volume, pyuria and bladder carcinoma recurrence. Methods: The clinical data of 305 patients who had post-void residual urine volume measured and preoperative pyuria were retrospectively collected. The patients were classified into three risk groups based on the presence of residual urine and pyuria: good (negative residual urine and pyuria), intermediate (positive residual urine or pyuria) and poor (positive residual urine and pyuria). Predictive factors for intravesical recurrence-free survival were statistically analyzed using Cox proportional hazard models and Kaplan--Meier methods. The propensity score matching method was used to adjust the patients' backgrounds. Results: The median follow-up period for all patients was 44 months. The presence of residual urine (P = 0.0164) and pyuria (P = 0.0233) were two independent prognostic factors for recurrence. After patients were classified into risk groups, the poor-risk group showed significantly shorter recurrence-free survival compared with that of the good- (P = 0.0002) and intermediate-risk groups (P = 0.0090). Even after matching, the presence of residual urine was related to short recurrence-free survival in male patients (P = 0.0012). When stratified by European Organization for Research and Treatment of Cancer risk groups, the presence of pyuria was related to short recurrence-free survival, especially for intermediate-risk patients without bacillus Calmette--Guérin treatment. Conclusions: Post-void residual urine and preoperative pyuria are two risks for recurrence-free survival in non-muscle-invasive bladder cancer. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal urinalysis (UA) results, such as pyuria or bacteriuria, increase the risk for antibiotic treatment even in the absence of urinary symptoms. In the emergency department (ED), patients presenting with psychiatric emergencies commonly undergo a medical assessment which includes a UA. We hypothesized that the rate of inappropriate antibiotic treatment for asymptomatic pyuria in the psychiatric medical population would decrease following implementation of an antimicrobial stewardship program (ASP) in the ED. Methods: This retrospective cohort study compared the treatment of adult patients presenting to the ED for medical assessment during a psychiatric emergency with noted pyuria between three time periods following implementation of an ASP: early ASP (2014), established ASP (2016), and mature ASP (2018). The ASP provided education and routine audit‐and‐feedback focused on reducing urine testing and eliminating treatment of asymptomatic pyuria. The primary end point was to compare rates of inappropriate treatment of asymptomatic pyuria between groups. Secondary end points included comparing appropriate agent selection and duration for patients who were prescribed antibiotics, prescriber documentation, and patient outcomes between groups. Results: A total of 180 patients with pyuria were included; 60 within each study group with 88.3% being asymptomatic. Inappropriate prescribing of antibiotics for asymptomatic patients at ED discharge decreased over time following ASP implementation (2014 = 40.4%, 2016 = 31.4%, 2018 = 17.6%; P =.036). Additionally, documentation noting a positive UA requiring antibiotic treatment decreased (2014 = 46.7%, 2016 = 40%, 2018 = 26.7%). Of the 62 patients treated with antibiotics, selection of a first‐line agent increased with ASP maturity (2014 = 15.4%, 2016 = 26.1%, 2018 = 69.9%; P =.002). Conclusion: Inappropriate treatment of asymptomatic pyuria in patients presenting to the ED with psychiatric emergencies decreased significantly over time following implementation of an ASP. EDs may benefit from ASP interventions aimed at decreasing reliance on UA interpretation in this patient population. [ABSTRACT FROM AUTHOR]

Background: Subclinical bacteriuria is defined as a positive bacterial urine culture in the absence of clinical evidence of urinary tract infection (UTI). Studies have reported that hyperthyroid cats have UTIs (mostly subclinical) with prevalence rates of 12%‐22%. Consequently, clinicians consider hyperthyroidism a risk factor for development of subclinical bacteriuria, and many recommend urine culture when evaluating hyperthyroid cats. Objectives: To compare the prevalence of subclinical bacteriuria (based on positive urine culture) in untreated hyperthyroid cats to that in euthyroid cats of similar age and sex. Animals Three hundred and ninety‐three hyperthyroid cats presented for radioiodine treatment and 131 euthyroid cats (≥7 years of age) presented for routine examination. Cats with signs of lower urinary tract disease were excluded. Methods: Prospective cohort study. Both hyperthyroid and euthyroid cats had urine collected by cystocentesis for complete urinalysis and culture. Data pertaining to age, sex, body condition, and serum thyroxine and creatinine concentrations also were acquired. Logistic regression was performed to evaluate for potential risk factors for subclinical bacteriuria. Results: Hyperthyroid cats showed a low prevalence of subclinical bacteriuria (4.3%), which did not differ from that found in euthyroid cats (4.6%). Of the signalment factors evaluated, only female sex was a significant risk factor (odds ratio [OR], 6.9; P =.002). Furthermore, positive urine cultures were more likely in specimens with dilute urine concentration (<1.035), pyuria, or microscopic bacteriuria. Conclusions and Clinical Importance: Hyperthyroid cats are not at risk for subclinical bacteriuria. In the absence of lower urinary tract signs, no clinical benefit exists in routinely performing urine cultures when evaluating hyperthyroid cats. [ABSTRACT FROM AUTHOR]

Background: Urine cultures are frequently recommended to rule out infection as a postrenal cause of proteinuria. Objective: Identify characteristics associated with bacterial growth in urine in proteinuric dogs. Animals: Four hundred and fifty‐one dogs admitted to a teaching hospital between January 2008 and January 2018 with urine protein‐to‐creatinine ratios (UPCs) >0.5. Methods: Retrospective study included dogs with a UPC, urinalysis, and quantitative urine culture (QUC) performed within a 72‐hour period by searching electronic records. Dogs with recent antimicrobial therapy, urine collected by methods other than cystocentesis, or UPC ≤0.5 were excluded. Signalment, comorbidities, serum BUN and creatinine concentrations, urinalysis findings, and QUC results were recorded. The association between these characteristics and presence of bacterial growth in urine was assessed by univariable and multivariable analysis. Results: Thirty of four hundred fifty‐one dogs (6.7%) had bacterial growth in urine. Of these, 18 (60.0%) had active urine sediment. Bacterial growth in urine was associated with pyuria (odd ratio [OR] 25.1, 95% confidence interval [CI] 7.9‐79.6, P <.001), bacteriuria (OR 11.1, 95% CI 3.2‐39.1, P <.001), and lower urinary tract disease (OR 6.7, 95% CI 1.9‐23.0; P =.0028). If QUC was prompted based on these criteria, 8/451 (1.8%) of proteinuric dogs would have had undetected bacterial growth. Conclusions and Clinical Importance: The proportion of proteinuric dogs with both inactive urine sediment and bacterial growth in urine was low, suggesting that QUC might not be necessary in the evaluation of all proteinuric dogs. An active urine sediment or lower urinary tract disease should prompt QUC for proteinuric dogs. [ABSTRACT FROM AUTHOR]

Background: Rapidly progressive glomerulonephritis has been described in dogs that seroreact to Borrelia burgdorferi, but no studies have compared clinicopathologic differences in Lyme‐seroreactive dogs with protein‐losing nephropathy (PLN) versus dogs with Borrelia‐seronegative PLN. Hypothesis/Objectives: Dogs with Borrelia C6 antigen‐seroreactive PLN have distinct clinicopathologic findings when compared to dogs with Borrelia seronegative PLN. Animals: Forty dogs with PLN and Borrelia C6 antigen seroreactivity and 78 C6‐seronegative temporally matched dogs with PLN. Methods: Retrospective prevalence case‐control study. Clinical information was retrieved from records of dogs examined at the University of California, Davis, Veterinary Medical Teaching Hospital. Histopathologic findings in renal tissue procured by biopsy or necropsy of dogs with PLN were reviewed. Results: Retrievers and retriever mixes were overrepresented in seroreactive dogs (P < .001). Seroreactive dogs were more likely to have thrombocytopenia (P < .001), azotemia (P =.002), hyperphosphatemia (P < .001), anemia (P < .001), and neutrophilia (P =.003). Hematuria, glucosuria, and pyuria despite negative urine culture were more likely in seroreactive dogs (all P ≤ .002). Histopathologic findings were consistent with immune‐complex glomerulonephritis in 16 of 16 case dogs and 7 of 23 control dogs (P = 006). Prevalence of polyarthritis was not different between groups (P =.17). Conclusions and Clinical Importance: C6 seroreactivity in dogs with PLN is associated with a clinicopathologically distinct syndrome when compared with other types of PLN. Early recognition of this syndrome has the potential to improve outcomes through specific aggressive and early treatment. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to describe clinical and laboratory characteristics of urinary tract infection (UTI) without significant pyuria in young children aged 2-24 months. Methods The subjects consisted of infants and young children with febrile UTI treated at Pusan National University Children's Hospital, Korea. Group A included 283 patients with definite UTI who fulfilled the revised American Academy of Pediatrics diagnostic criteria, and group B included 19 patients with presumed UTI who had significant culture of uropathogens without pyuria, bacteriuria or other focus of infection. Results Duration of fever before hospital visit in group B was significantly shorter than in group A (17.7 ± 14.0 vs 34.5 ± 30.7 h). Most patients in group B (17/19, 89.5%) came to the hospital within 24 h of onset of fever. Acute scintigraphic lesions were found in 47.8% of patients in group A and 50% in group B. Underlying urological abnormalities such as vesicoureteral reflux and obstructive uropathy were found in 24.5% of patients in group A and in 33.3% of patients in group B ( P = 0.74). Conclusions Clinicians cannot exclude UTI on the absence of pyuria in young children aged 2-24 months. [ABSTRACT FROM AUTHOR]

Objectives To determine the frequency of bacteriuria in dogs presenting for elective surgery, to compare the frequency of bacteriuria in dogs presenting for orthopaedic (non-neurological) procedures to that of dogs presenting for soft tissue procedures and to measure the agreement of microscopic visualisation of bacteria in urine sediment with the occurrence of bacterial growth on culture. Methods Prospective cohort study of 140 client-owned dogs. Urine was collected via prepubic cystocentesis prior to or immediately after induction of anaesthesia. Urine was submitted for quantitative bacteriological culture and urinalysis. The dogs' age, sex, weight and breed were recorded, as well as the surgical procedure performed. Results In total, 80 orthopaedic and 60 soft tissue surgical cases were included in the study; 3 dogs (2.1%) returned bacterial growth on culture (positive urine culture) and 19 (13.6%) recorded urine sediment with pyuria and/or bacteriuria on urinalysis (positive urinalysis). All dogs with positive urine culture were female and two of them underwent orthopaedic procedures. Each bitch had growth of Escherichia coli >105 CFU/m L. The agreement between positive urinalysis and positive urine culture was poor (κ = 0.15). Conclusions The prevalence of bacteriuria in dogs without clinical signs of urinary tract infection in this population was low (2.1%). An at-risk population could not be identified because of the small number of positive outcomes. A positive urinalysis showed poor agreement with urine culture results and therefore the decision to treat without performing a urine culture is not advised. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to identify factors for differentiating roseola infantum from urinary tract infection ( UTI) and to describe a cohort of infants diagnosed with roseola infantum and sterile pyuria. Methods The medical records of infants diagnosed with roseola infantum or UTI were examined. Multivariate analysis was performed to identify factors associated with UTI. Demographic and clinical variables were compared between infants who had roseola infantum with or without sterile pyuria. Result There were 301 infants included: 158 in the roseola group (21, 13.3% with sterile pyuria) and 143 in the UTI group. The relative risk of UTI over roseola infantum: increased with leukocytosis (white blood cell [ WBC] count >10 000/mm3, odds ratio [ OR] = 85.62) and pyuria ( OR = 18.97); decreased with age ( OR = 0.90); increased in boys ( OR = 2.48); increased with WBC count 4000-10 000/mm3 ( OR = 4.24); and decreased with duration of fever ( OR = 0.84). There was a significantly higher proportion of girls in the roseola pyuria group (81.0%) compared with the no pyuria group (44.5%, P = 0.002). A significantly higher proportion of infants in the roseola pyuria group (76.2%) received antibiotics than infants in the no pyuria group (38.0%, P = 0.002). Conclusion Leukocytosis is the strongest predictor of UTI over roseola infantum. Sterile pyuria may occur in infants with roseola infantum. [ABSTRACT FROM AUTHOR]

Background: Although Kawasaki disease (KD) often presents with sterile pyuria, bacterial pyuria (urinary tract infection [UTI]) occasionally occurs. Methods: This was a retrospective cohort study of 285 children with KD diagnosed between 1995 and 2005. Among these patients, a total of 210 patients underwent routine urine tests and 75 children underwent urine culture tests. This study was conducted to investigate the incidence, clinical manifestations, management and outcome of KD with pyuria. Results: The incidence of pyuria was 29.5% (62/210). Among the 75 children undergoing urine culture tests, 34 had sterile pyuria (45.3%), eight had bacterial pyuria (10.7%), two had UTI without pyuria (2.7%) and 31 had neither pyuria nor UTI (41.3%). When pyuria was used as a predictor of KD with UTI, the positive and negative predictive values were 19% and 93.9%, respectively. There were no significant differences in demographic data, clinical presentations, laboratory results, duration of fever, ratio of resistant KD or risk level, except in the nitrite test, between both groups. Conclusions: Pyuria was not always sterile in patients with KD. Although there was no different clinical phenotype or coronary outcome in KD patients with or without UTI, we suggest that UTI should be considered and evaluated in KD patients with pyuria, a positive nitrite test or a positive result of urine culture. If UTI is definitively diagnosed, the patient should be treated for a UTI as well as for KD and complete post-UTI work-up is recommended. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that diseases that promote isosthenuria predispose to urinary tract infections because of a lack of the common bacteriostatic properties present in concentrated urine. Objectives: The purpose of this study was to assess the clinicopathologic risk factors for positive urine culture outcome in cats with chronic kidney disease (CKD), diabetes mellitus (DM), uncontrolled hyperthyroidism (HT), or lower urinary tract disease (LUTD). Methods: For this retrospective study, medical records of all cats in which a urinalysis and aerobic bacterial urine culture were performed between January 1995 and December 2002 were reviewed. Signalment, body weight, and clinicopathologic data were recorded. Based on the medical records, cats were diagnosed with CKD, DM, HT, or LUTD. Prevalence odds ratios and 95% confidence intervals were calculated using logistic regression. Multivariate models were created for each variable of interest while controlling for the confounding effect of disease group. Results: Six hundred fourteen cats met the criteria for inclusion in the study. Overall, positive urine cultures were identified in 16.9% of cats with CKD, 13.2% of cats with DM, 21.7% of cats with HT, and 4.9% of cats with clinical signs of LUTD. Decreasing urine specific gravity was not associated with positive urine culture when controlled for disease but pyuria, bacteriuria, and hematuria were all associated with positive urine culture outcome. Persians, females, increasing age, and decreasing body weight were all associated with positive urine culture outcome. Conclusions: Performing a urine culture sample based solely on the presence of isosthenuria does not seem warranted. Further studies are warranted to help identify host predisposing factors for urinary bacterial colonization in cats with these diseases. [ABSTRACT FROM AUTHOR]

Aim: The assumed necessity of antimicrobial prophylaxis prior to cystoscopy is controversial. In this study, the rate of bacteriuria, pyuria and bacteremia in outpatients who underwent cystoscopy without antimicrobial prophylaxis is investigated prospectively. Methods: The study included 75 patients who underwent cystoscopy for various indications and had sterile urine prior to intervention. A clean midstream urine sample was obtained 24 h before and 48 h after the procedure. Blood cultures were taken 1 h after cystoscopy. Patients were questioned for newly developed symptoms 48 h after cystoscopy. Blood cultures were taken again from patients who presented with fever. Results: Six patients (8%) developed significant bacteriuria, and six patients (8%) developed pyuria without significant bacteriuria. Bacteremia was not determined in any of the patients. The association between presence of pyuria prior to the procedure and development of bacteriuria after the procedure was significant ( P < 0.05). Four patients out of six who had bacteriuria were asymptomatic. In our study we found significant bacteriuria after cystoscopy in 8% of patients, and no bacteremia. Conclusions: Thus we conclude that cystoscopy is a safe and well-tolerated procedure. Antimicrobial prophylaxis should not be administrated unless specific indications are present. [ABSTRACT FROM AUTHOR]

Objectives To investigate the prognostic value of preoperative pyuria in patients with non-muscle-invasive bladder cancer. Methods We retrospectively reviewed data from 237 patients diagnosed with non-muscle-invasive bladder cancer. Pyuria was defined as urine containing ≥5 white blood cells per high power field. The association between clinicopathological factors and recurrence was assessed by Cox univariate and multivariate analyses. Results Preoperative pyuria was found in 116 (49.0%) patients. Pyuria was significantly associated with advanced age, positive cytology, multiple tumors, large tumor size, non-papillary tumors, T1 tumors and high-grade tumors. In univariate analysis of the entire patient population, pyuria, positive urine cytology, multiple tumors, pT1 tumors and no bacillus Calmette-Guérin were significantly associated with recurrence. Multivariate analysis showed that pyuria was an independent predictor of recurrence (hazard ratio 3.332, 95% confidence interval 2.052-5.410; P < 0.001), along with positive urine cytology, multiple tumors and no bacillus Calmette-Guérin therapy. Subanalysis of the patients who underwent bacillus Calmette-Guérin therapy also showed that pyuria was an independent predictor of recurrence (hazard ratio 2.062, 95% confidence interval 1.085-3.918, P = 0.027). The 2-year recurrence-free survival rate for patients with pyuria was significantly lower than for patients without pyuria (65.5% vs 80.7%; P = 0.027). Conclusions Preoperative pyuria seems to be significantly associated with recurrence in patients with non-muscle-invasive bladder cancer, and it might be a useful predictor for recurrence after bacillus Calmette-Guérin therapy. [ABSTRACT FROM AUTHOR]