What Do Squamous Epithelial Cells in Urine Mean?

Squamous epithelial cells in urine usually mean the sample was contaminated by cells from another part of the body, most often the skin around the genitals. Cleveland Clinic notes that urine normally contains some epithelial cells, but squamous cells on a report most likely point to contamination during collection.

This guide is for people reading a urinalysis report that mentions squamous epithelial cells. It explains the common meaning and the questions worth asking. It cannot tell you whether your own result is significant; only the clinician who knows your symptoms and history can judge that.

Do not let a possible contamination result delay care for symptoms. The NHS advises calling emergency services or going to an emergency department if someone becomes confused, drowsy or has difficulty speaking. In older or frail people, new confusion or agitation can be the main sign of a urinary infection.

Seek urgent advice from a doctor or local urgent-care service if:

• You have fever, chills, lower back or side pain, or nausea and vomiting, which the CDC lists as warning signs of a possible kidney infection.
• Urinary symptoms get worse quickly or do not improve within about 48 hours, or you see blood in your urine (NHS).
• You are pregnant, have diabetes, use a urinary catheter or have a weakened immune system and develop urinary symptoms (NHS).
• A baby under 3 months has a temperature of 38 °C (100.4 °F) or higher (CDC).

Epithelial cells line surfaces of the body. Squamous cells are flat cells found on the skin and on the outer parts of the genital area, including the area around the opening of the urethra and the vagina. When urine passes over these surfaces, or the cup touches the skin, some of these cells can end up in the sample.

Cleveland Clinic also points out that bacteria and yeast from outside the urinary tract can contaminate a sample, especially in people with a vagina, and that vaginal discharge or menstrual blood can interfere with results. This is why a report showing squamous cells is often read together with the other findings rather than on its own.

Some epithelial cells come from the lining of the urinary tract itself. Cleveland Clinic notes that high numbers of epithelial cells can sometimes point to infection, inflammation or, less commonly, cancer in the urinary tract. Which type of cell is present, how many and what else is on the report all affect the meaning.

Laboratories report epithelial cells in different ways, for example as few, moderate or many, or as a count per field. Units and cut-offs vary between labs, so compare your result only with the reference information printed on your own report, and ask the clinician how they read it.

A contaminated sample can make other findings less reliable. Bacteria, white blood cells or yeast seen on the report may have come from the skin or genital area rather than the bladder. MedlinePlus notes that a urine culture can sometimes grow more than one type of bacteria or only a small amount, which can be harder to interpret.

This works both ways. A contaminated sample can suggest infection when there is none, and it can also leave real symptoms unexplained. If your symptoms and results do not match, the guide on UTI symptoms with a negative urine culture covers related questions.

Most urine tests use a clean-catch, midstream sample. MedlinePlus explains that this method is used to stop germs from the penis or vagina getting into the sample. Always follow the specific instructions from your clinic or laboratory, as they may differ. The usual steps described by MedlinePlus and Healthdirect are:

• Wash your hands with soap and water.
• Clean the genital area with the wipe provided. People with a vagina should spread the labia and clean the inner folds; people with a penis should clean the tip, pulling back the foreskin if present.
• Pass a small amount of urine into the toilet first, then collect the middle part of the stream in the cup.
• Do not let the cup touch your genitals, and do not touch the inside of the cup or lid.
• Close the lid tightly and return the sample as instructed. If you collect it at home, ask how to store it; MedlinePlus advises refrigerating it in a bag until it reaches the lab.

Not always. Whether a new sample is needed depends on why the test was done, your symptoms and what the rest of the report shows. A clinician may decide the result still answers the question, or may ask for a fresh clean-catch sample. In some situations a sample can be taken with a thin tube (catheter) passed into the bladder, which MedlinePlus describes as draining urine directly into a sterile container.

If you are asked to repeat the test, tell the team if you were menstruating, had vaginal discharge or found the collection difficult last time. Healthdirect also advises telling your doctor or nurse about any medicines you take, as some can affect urine results. Do not start or stop medicines based on the report alone.

These questions can help you understand what the result means for you:

• Does this result suggest contamination, and does that change how you read the bacteria or white cells on my report?
• Was a urine culture done as well as a dipstick or microscopy, and what did it show?
• Do I need a new sample? If so, should it be clean-catch or collected another way?
• Is there anything about the timing of collection, such as my period, that I should change next time?
• Which symptoms should make me contact you before the results are back?

On SameCase, patients and verified doctors share de-identified cases. Reading how other people with a similar report described their symptoms, sample collection and follow-up can help you notice details to mention and questions to ask. Other cases cannot tell you what your own result means, and they do not replace advice from the clinician treating you.