Urine testing no longer routine

Q. At my last physical, the doctor did not collect urine for tests. Shouldn't that always be part of a physical?

A. Urinalysis used to be routine during check-ups, typically to test for traces of blood, protein, or sugar. This helped to identify people with hidden kidney disease or diabetes. Currently, most diseases that we can detect with urinalysis can be diagnosed much earlier with blood tests. Since blood testing is more common in doctors' offices now and urinalysis adds little new information, many doctors do not do it routinely.

Guidelines for doctors generally discourage routine urinalysis because it triggers too many false alarms for cancer. This is because finding a small amount of blood in the urine can be an early warning of bladder or kidney cancer, but it could also be one of several other common things, such as kidney stones or an enlarged prostate. Ruling out cancer may require invasive testing, which usually does not find cancer in the end anyway. As a result, urinalysis leads to a lot of unnecessary testing.

But sometimes urinalysis is appropriate during an annual physical. People with diabetes are at risk for kidney disease, which in its earliest stages can cause a slight rise in protein in the urine. Or, if someone reports having to urinate frequently, or pain with urination, a urinalysis can help identify an infection. In other words, many doctors are now more likely to do urinalysis to diagnose specific conditions—such as infection or diabetes—rather than as a "just in case" check-up. Therefore, if you have diabetes or problems with urination, a urine test could be informative. For everyone else, it can be routinely omitted.

— William Kormos, M.D.
Editor in Chief, Harvard Men's Health Watch