Three tube test for hematuria

What is the three tube test for hematuria?

The three tube test is performed to determine the location of bleeding in the urinary tract.

The three tube test also known as the three container method.

How the three tube test is done?

Three consecutive samples of the urine stream are collected:

  • The first urine sample of 10 to 15 mL
  • The midstream urine sample of 30 to 40 mL
  • The last urine sample of 5 to 10 mL

How to understand the results of the three tube test?

  1. Initial hematuria
  2. Terminal hematuria
  3. Hematuria in all three samples is seen in lesions that may be anywhere above the bladder neck (bladder, ureters, or kidneys).

Initial hematuria

Hematuria (or predominance of RBCs on urine microscopy) primarily in the first sample

What does the initial hematuria indicate?

The initial hematuria is suggestive of an anterior urethral source of bleeding

Terminal hematuria

What does the terminal hematuria indicate?

Terminal Hematuria primarily at the end of the urine stream is suggestive of a lesion at the bladder trigone (bladder neck) or a posterior urethra.


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