Urine Bag as a Modern Day Matula

Abstract

Since time immemorial uroscopic analysis has been a staple of diagnostic medicine. It received prominence during the middle ages with the introduction of the matula. Urinary discoloration is generally due to changes in urochrome concentration associated with the presence of other endogenous or exogenous pigments. Observation of urine colors has received less attention due to the advances made in urinalysis. A gamut of urine colors can be seen in urine bags of hospitalized patients that may give clue to presence of infections, medications, poisons, and hemolysis. Although worrisome to the patient, urine discoloration is mostly benign and resolves with removal of the offending agent. Twelve urine bags with discolored urine (and their predisposing causes) have been shown as examples. Urine colors (blue-green, yellow, orange, pink, red, brown, black, white, and purple) and their etiologies have been reviewed following a literature search in these databases: Pubmed, EBSCO, Science Direct, Proquest, Google Scholar, Springer, and Ovid.

Purple Urine Bag Syndrome in a Critically Ill Patient: Case Report

“…Indole is then absorbed and reaches the liver through the portal system where it's transformed into indoxyl sulfate. When excreted in the urine, it may come into contact with bacteria with indoxyl phosphatase and sulfatase activity such as Providencia species, Escherichia coli, Pseudomonas aeruginosa, Morganella, Klebsiella pneumoniae, and Proteus mirabilis [1,2,5]. The bacterial enzymes break down indoxyl sulfate to form indigo and indirubin pigments which interact with the material of the drainage system, especially PVC, as part of the reaction that gives off the purple color change [3].…”

“…Macroscopic examination is an important aspect of urinalysis, especially in patients with urinary catheterization [1]. Possible alterations may include urine discoloration due to endogenous or exogenous pigments [2]. Color changes could provide useful information about possible underlying medical conditions.…”

Hulk-Like Urine: A Case of Green Urine Caused by Flupirtine Intoxication

“…The alteration of the normal color of urine to green, as described in this case, immediately led to a comparison to The Incredible Hulk, the green superhero of Marvel Comics. Greenish urine is not a pathognomonic side effect of flupirtine and has been described in cases of consumption or intoxication by some drugs and dyes; it is also a characteristic of some diseases (Table 4) [8][9][10][11]. In the Middle Ages, greenish urine was associated with a choleric personality, and in some traditional medicines, namely Persian, it is associated with the dominance of coldness in the body as a result of humoral imbalance and fluid depletion [8,12].…”

Purple urine bag syndrome: An unusual but important manifestation of urinary tract infection. Case report and literature review

“…10 Importantly, this enzyme is most active in the presence of alkaline urine, although cases of PUBS in acidic urine have been noted. 11 However, key laboratory findings include urinary pH ⩾ 7, visual inspection of the urine and urine culture of culprit organisms. 12 Several bacteria, the majority of which are gramme negative, have been linked to the development of indicans such as Pseudomonas aeruginosa, E. coli, Proteus mirabilis, Providencia rettgeri, Klebsiella pneumoniae , group B strep and Proteus vulgaris with a mixture of these species usually present in urinary isolates in PUBS with not all organisms of the same species capable of producing the sulphatase and phosphatase enzymes.…”