Bladder Stimulation Technique for Urine Collection in the Pediatric Emergency Department

June 17, 2026 updated by: Aytaç Göktuğ, Istanbul Medeniyet University

Can the Bladder Stimulation Technique Solve the Urine Collection Chaos in the Pediatric Emergency Department?

The purpose of this prospective, quasi-experimental study is to evaluate the efficacy of the Bladder Stimulation Technique (BST) compared to the traditional urine collection bag method in non-toilet-trained infants presenting to the Pediatric Emergency Department. The primary objective is to determine whether BST can significantly reduce urine contamination rates and the time required for successful sample collection. By comparing these two non-invasive methods, the study aims to provide a faster, cleaner, and more reliable diagnostic approach to solve the operational challenges of urine collection in acute pediatric care

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Active, not recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Diagnosing urinary tract infections (UTIs) in non-toilet-trained infants is a daily and critical challenge in pediatric emergency departments. In this highly vulnerable group, a UTI can rapidly progress to severe complications, making an accurate diagnosis via a sterile or very clean urine sample absolutely essential. Currently, the most common non-invasive method for collecting urine from these infants is the adhesive urine bag. However, this method has significant drawbacks. Bag samples have notoriously high contamination rates-often exceeding 50%-because bacteria from the baby's skin or stool easily mix with the urine.

When a urine sample is contaminated, it frequently leads to false-positive results. This forces physicians to either prescribe unnecessary antibiotics to a very young infant or subject the baby to invasive, painful procedures like urethral catheterization to secure a sterile sample. Furthermore, waiting for an infant to naturally void into a bag is highly unpredictable, often taking hours. This waiting period increases the length of hospital stays, frustrates parents, and creates operational bottlenecks in busy emergency departments.

The Proposed Intervention: Bladder Stimulation Technique (BST) To address these clinical and operational challenges, clinicians are exploring alternative non-invasive methods. The Bladder Stimulation Technique (BST) is a safe, completely non-invasive maneuver that involves gently tapping and massaging the infant's lower abdomen (suprapubic area) and lower back (lumbar region) in a specific sequence. This gentle stimulation triggers the infant's natural reflex to urinate, allowing healthcare providers to catch a midstream urine sample directly into a sterile container.

Study Design and Methodology This is a prospective, quasi-experimental comparative study conducted in a high-volume Pediatric Emergency Department. The study is designed to directly compare the traditional adhesive urine bag method with the Bladder Stimulation Technique.

The study will specifically include infants younger than 6 months of age who present to the emergency department and require a urine sample for clinical evaluation. Eligible infants will be evaluated using one of the two collection methods, and the study will rigorously track and compare the outcomes of both approaches in real-time.

Primary and Secondary Objectives

The study focuses on three main questions regarding this specific age group:

Contamination Rates: Does BST provide a cleaner urine sample compared to the bag method in infants under 6 months, thereby significantly reducing the rate of false-positive cultures?

Time Efficiency: Does BST reduce the time required to successfully collect a urine sample compared to waiting for a bag collection?

Success Rate: What is the overall success rate of obtaining a viable urine sample using BST versus the bag method within a standard emergency room timeframe? The findings of this study have the potential to immediately change clinical guidelines and daily practices in acute pediatric care. If the Bladder Stimulation Technique proves to be faster and less prone to contamination than the traditional bag method, it will serve as a crucial "diagnostic firewall." For parents, this means less time waiting in the emergency room, protection from unnecessary antibiotic treatments, and avoiding the pain and trauma of invasive catheterization for their babies. For healthcare systems, it offers a cost-effective, evidence-based solution to resolve diagnostic dilemmas and operational bottlenecks in emergency departments.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
124

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Infants strictly under 6 months of age.
  • Patients presenting to the pediatric emergency department who require a urine sample collection for any clinical indication (e.g., fever without a source, suspected urinary tract infection).
  • Infants who are able to be fed orally or enterally (as the protocol requires the procedure to be performed 20 minutes after feeding to ensure bladder volume).
  • Presence of informed written consent from a parent or legal guardian.

Exclusion Criteria:

  • Infants aged 6 months or older.
  • Patients requiring immediate life-saving resuscitation or those who are hemodynamically unstable.
  • Patients with known congenital anomalies of the genitourinary tract.
  • Patients with known neurological disorders that may affect normal bladder function or voiding reflexes (e.g., neural tube defects, spina bifida).
  • Presence of skin lesions, active infections, trauma, or surgical incisions in the paravertebral (lower back) or suprapubic (lower abdomen) areas that would contraindicate physical massage and tapping.
  • Patients with any clinical contraindication to feeding.
  • Refusal of parental consent.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Arm 1: Bladder Stimulation Technique
Infants in this arm will undergo the Bladder Stimulation Technique. This completely non-invasive method involves a specific sequence of paravertebral (lower back) massage and suprapubic (lower abdomen) tapping to trigger the infant's natural voiding reflex, allowing for a midstream urine sample to be collected directly into a sterile container.
Procedure: Bladder Stimulation Technique
In the intervention group, the Bladder Stimulation Technique (BST) was performed. The infant was held safely suspended in the air by their armpits by a researcher to relax the abdominal muscles. The physician then initiated a stimulation cycle consisting of 30 seconds of gentle paravertebral (lower back) massage, followed immediately by 30 seconds of light suprapubic (lower abdomen) tapping. This 1-minute cycle was repeated continuously for a maximum of 5 minutes. The moment the natural voiding reflex was triggered and the infant began to urinate, a midstream urine sample was directly caught into a sterile specimen container
Active Comparator: Arm 2: Traditional Urine Bag Method
Infants in this arm will undergo the current standard of care. A standard, sterile adhesive urine collection bag will be applied to the infant's perineal area. The patient will be monitored until natural voiding occurs into the bag
Procedure: Traditional Urine Bag Application
The current standard care method for urine collection in non-toilet-trained infants. The infant's perineal area is cleaned, and a standard, sterile pediatric adhesive urine collection bag is attached. The infant is then closely monitored in the emergency department until spontaneous natural voiding occurs into the bag.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Success Rate of the Bladder Stimulation Technique and Influencing Factors
Time Frame: From the start of the stimulation maneuver until at least 1 cc of urine is obtained (maximum of 5 minutes)
The primary objective is to evaluate the percentage of successful urine collections, strictly defined as obtaining at least 1 cc (mL) of clean-catch midstream urine, achieved specifically by using bladder stimulation maneuvers (paravertebral massage and suprapubic tapping). Additionally, this outcome evaluates the clinical and demographic factors (e.g., patient age, gender, weight) that influence the success of this specific maneuver.
From the start of the stimulation maneuver until at least 1 cc of urine is obtained (maximum of 5 minutes)

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Effect on Emergency Department Waiting Time
Time Frame: Up to 5 minutes for the bladder stimulation group, and until at least 1 cc of urine is obtained for the traditional bag group
To evaluate and compare the effect of both urine collection methods (the bladder stimulation technique versus the traditional adhesive bag) on the total waiting time in the emergency department, measured from the initiation of the procedure until at least 1 cc of urine is successfully obtained.
Up to 5 minutes for the bladder stimulation group, and until at least 1 cc of urine is obtained for the traditional bag group

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Effect on Specimen Contamination Rates
Time Frame: Up to 72 hours
To evaluate and compare the effect of both urine collection methods on the rates of urine culture contamination, in order to determine which method yields more reliable clinical samples.
Up to 72 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Istanbul Medeniyet University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 1, 2026

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
April 30, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 15, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 12, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 12, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 17, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 22, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 17, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • IstabulMU-PED-AG-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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