Mid-stream urine collection system: an interview with Giovanna Forte, Managing Director, Forte Medical

Giovanna Forte ARTICLE IMAGE

What is a mid-stream urine sample and why do healthcare professionals request them?

The mid-stream (MSU) is urine from the bladder, which carries the information clinicians need to accurately identify and diagnose a UTI, or in the case of antenatal patients, make sure all is well.

The problem with first-flush urine is that it can wash bacteria, flora and debris off the skin and into the sample, leading to a false-positive or inaccurate result, which in turn can lead to retesting or unnecessary broad-spectrum antibiotic prescribing.

In short, with Peezy msu you get upwards of 8 accurate specimens for the price of one retest.

Peezy msu is especially valuable in pregnancy, for pre-assessment tests and of course, urology and urogynaecology.

What difficulties do patients currently face when trying to collect a mid-stream urine sample?

Astonishingly, many hospitals and surgeries give the patient a standard 22mm diameter Universal Container to pee into.

Not only does this mean having to start-stop-start-and-aim the stream to capture the MSU, the somewhat comedic, hit-and-miss process means that hands and toilet environment become soiled.

Thrusting ones hands willingly into our own urine is hardly common practice; that we are expected to do so in order to capture an important specimen essential to diagnosis hardly chimes with the concept of modern medicine and leads to pretty shabby infection control by any standards.

Even if a plastic funnel or jug is provided, the process remains messy, undignified and all too frequently inaccurate.

How frequently do patients have to be retested due to contaminated urine samples?

In the UK, the national average contamination rate is between 15% and 30%. Guidelines recommend that contaminated samples be retested.

Often they’re not, because the cost of retesting is high (around £10 for the lab analysis plus frontline resources) and it means delaying treatment.

In the case of a UTI, an untreated patient is a jolly sore and unhappy patient. This is often when broad-spectrum antibiotics are prescribed.

Peezy msu makes inaccuracy and delay things of the past because it reduces the contamination rate to between 4-7%, which means the patient is far more likely to benefit from right-first-time analysis, diagnosis and treatment.

The cost and efficiency savings are huge from clinical and patient perspectives.

Please can you give a brief introduction to the Peezy msu?

Peezy msu is the new gold standard for urine collection. It is a rather nifty device designed to make sample delivery easy, accurate, hygienic and dignified for women.

Hospital evaluations show that men prefer to use it too (you can’t beat a good gadget!).

The “right-first-time” design saves on repeat testing, repeat appointments, repeat visits and unnecessary antibiotic prescribing. In short, it brings Best Practice to specimen collection.

How was the Peezy msu developed?

Dr Vincent Forte, General Practitioner and medical author, noticed he was seeing the same women for the same UTI problems in surgery because he could not get a good quality urine specimen from which to accurately diagnose and treat their problems.

These patients also complained to him about the mess and indignity of urinating into a narrow container.

A naturally inventive problem-solver, Vincent came up with the Peezy msu system. You will notice we share a surname: he is my brother.

How does the Peezy msu separate the mid-stream urine from the first part and the last part?

Peezy msu comprises a cleverly designed funnel, a small compressed cellulose sponge positioned at the open base of the funnel and a standard Universal Container which screws onto the side of the device.


When the patient releases his or her urine, the first 10-12ml of potentially contaminated first-flush escapes into the toilet; this modest flow expands the sponge, which blocks the escape route.

The valuable MSU is then pushed up the funnel and into the Universal Container. Excess urine is diverted straight into the toilet without returning to the funnel. This means it cannot overflow and works between 10ml and 40ml per second.

As we like to say: dry bottle, dry loo, dry you … pure MSU.

What impact do you think the Peezy msu will have on contamination and retest rates?

Peezy msu reduces contamination rates from 15%-30% to between 4% and 7%; this means at worst a near-50% improvement and at best, nearly 90%.

The cost and efficiency savings opportunities are huge at a time when the NHS desperately needs to reduce costs.

Where is the Peezy msu currently available?

In the UK Peezy msu is prescribable (handy for the elderly and antenatal patients). Otherwise, it is on the NHS Supply Chain, which makes it readily available to all NHS Trusts.

In the private sector HCA and Spire Healthcare were the first to improve things for their patients – the rest will no doubt catch up soon.

Do you have plans to make the Peezy msu available in other countries?

Yes. Peezy msu is FDA approved in the USA and opportunities are opening in other key territories too. Europe, the Far East, Middle East and Australasia.

What other products are you currently working on?

The Peezy V1 collects first-void male urine. This was primarily designed to assist with prostate cancer testing but will work extremely well for accurate chlamydia testing too.

There are a couple of other specimen collection systems in the pipeline, but I can’t talk about them yet.

What are Forte Medical’s plans for the future?

To deliver accurate diagnoses, kinder more hygienic care for patients and all-important cost savings for healthcare providers the world over.

Where can readers find more information?


About Giovanna Forte

Giovanna Forte BIG IMAGEGiovanna co-founded Forte Medical with Dr Vincent Forte in 2006 to take his healthcare invention from concept to market and establish a new gold standard in urology analysis. This adventure has led to a greater understanding of specimen collection in a wider context, and plans to improve it.

For 16 years prior, she ran Forte Communication an imaginative and successful media relations’ agency that built business and profile for clients. Sectors ranged from architecture, art, design and education to environmental engineering and luxury vodka.

Giovanna is sometimes invited to speak to young start-up businesses and students about enterprise, innovation, fund-raising and PR.

April Cashin-Garbutt

Written by

April Cashin-Garbutt

April graduated with a first-class honours degree in Natural Sciences from Pembroke College, University of Cambridge. During her time as Editor-in-Chief, News-Medical (2012-2017), she kickstarted the content production process and helped to grow the website readership to over 60 million visitors per year. Through interviewing global thought leaders in medicine and life sciences, including Nobel laureates, April developed a passion for neuroscience and now works at the Sainsbury Wellcome Centre for Neural Circuits and Behaviour, located within UCL.


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