Abstract
Background: Urinary tract infections (UTIs) affect approximately 150 million people annually and are among the most prevalent infectious diseases globally. Despite the availability of urine culture as the diagnostic gold standard, its 24–48 hour turnaround limits timely clinical decision-making. Urine microscopy offers a rapid, cost-effective alternative, yet its full diagnostic potential remains underutilised particularly in resource-limited settings.
Methods: This cross-sectional study enrolled 65 female patients with suspected or confirmed UTIs from the Department of Pathology, Mayo Hospital Lahore, over three months. Midstream urine samples were processed and microscopically examined for pus cells (WBC/HPF), red blood cells (RBC/HPF), bacteriuria morphology, crystal types, and cast formation. Data were analysed using SPSS v25 with Mann-Whitney U, Kruskal-Wallis H, Chi-square, and Spearman correlation tests.
Results: Acute uncomplicated cystitis was the predominant diagnosis (53.8%). Mean pus cell count was 34.77 WBC/HPF (SD = 26.84), with a significant linear correlation between pyuria severity and bacteriuria burden (p = .036). Microscopic isomorphic haematuria was identified in 64.6% of patients, and RBC counts varied significantly across haematuria types (H = 45.139; p < .001). Urine pH strongly predicted crystal type (H = 40.105; p < .001): triple phosphate crystals predominated in alkaline urine and uric acid crystals in acidic urine. Pyuria and haematuria showed a significant positive correlation (rho = .562; p < .001). Conclusion: Routine urine microscopy is a diagnostically powerful tool capable of characterising UTI severity, predicting bacteriuria burden, and identifying crystal-forming conditions. Its wider adoption in resource-constrained environments is strongly justified