TENA U-test for easy in-pad detection or exclusion of urinary tract infections

TENA U-test offers easy and comfortable in-pad detection of urinary tract infections in incontinent individuals with symptoms.

The test is placed in a clean pad at regular pad change. No separate urine collection is needed. Both urine collection and analysis take place while the test is in the pad. The results are available 15 minutes after urination and are valid up to 24 hours.


TENA U-test is quick, non-intrusive and comfortable for the individual to wear. No separate urine collection is needed. Both urine collection and analysis take place while the test is in the pad, meaning painful catheterisation is avoided.

More time to care

TENA U-test is integrated in normal pad-changing routines. Handling the test takes five minutes at most. This is 70% faster, on average, than traditional methods with separate urine collection and analysis.[1] Using TENA U-test allows more time for more rewarding care.

Clinically proven [2]

TENA U-test is an in-pad detection or exclusion aid for recognition of urinary tract infections through the detection of nitrite and/or leukocytes in urine. It has been successfully evaluated in a clinical trial and is EU certified as an an in vitro diagnostic device (IVD).

UTIs affect up to 50% of individuals in nursing homes

Urinary tract infections (UTIs) are the most common bacterial infections in nursing homes. [3] There are also other conditions with similar symptoms, which is why it’s always important to detect or exclude UTIs to initiate the correct treatment.

Improved well-being for individuals and better working environment for carers

TENA U-test is an integrated in-pad detection aid for collecting and analysing urine. It’s a brand new way of detecting urinary tract infections in incontinent residents. No separate urine collection is needed. The in-pad solution has been successfully evaluated in a clinical trial and proven to improve individual's well-being and working environment for carers.

89% of nurses found that TENA U-test increases individual's comfort [4]

According to a case study with 15 nursing home wards in Sweden and the Netherlands, 89% of the nurses found that TENA U-test increases individual's comfort. The fieldwork and data collection were conducted by Scandinfo.

100% of nurses experienced an improved working environment with TENA U-test [4]

According to a case study with 15 nursing home wards in Sweden and the Netherlands, 100% of the nurses experienced an improved working environment. The fieldwork and data collection were conducted by Scandinfo.

TENA U-test is 70% faster than traditional methods

Placing, removing and reading TENA U-test takes a maximum of five minutes. Using traditional methods, including separate urine collection and analysis, takes on average 16.8 minutes. This means that TENA U-test is 70% faster, on average, compared to procedures that involve urine collection with cup, pot, catheterisation, urine pad and dipstick [1].

Benefits for individuals, staff and the entire nursing home

TENA U-test is specially developed for incontinent individuals with symptoms of urinary tract infections. The quick and comfortable process of using the in-pad detection aid also benefits staff and the nursing home.

TENA U-test

Benefits for individuals

  • No need to provide a urine sample
  • Quick, non-intrusive procedure
  • Comfortable to wear and maintains dignity
  • Avoids painful catheterisation

Benefits for staff

  • No need to collect a urine sample gives less stress and frustration
  • Integrates into regular pad-changing routines
  • More time for more rewarding care

Benefits for nursing home

  • More efficient daily routines

  • Fewer complications

  • Less hospitalisation

  • Improved quality of care

Easy to use and interpret

Place TENA U-test face down in a clean pad and remove at next pad change. Check the test card. Results are valid up to 24 hours.

  1. As soon as enough urine has been collected, the validity indicator changes from green to orange.

  2. The nitrite indicator will change from white to pink and/or the leukocyte indicator from white to violet if the test is positive for urinary tract infections.

  3. The validity indicator on a new TENA U-test is green.


How to apply TENA U-test

TENA U-test

Step 1

Apply TENA U-test into the pad directly after removing from packaging.

TENA U-test

Step 2

Put on the pad as normal. Test results are available 15 minutes after urination.

TENA U-test

Step 3

Follow normal pad changing routines. Remove TENA U-test from pad at pad change.

TENA U-test

Step 4

Read results of TENA U-test. Valid up to 24 hours.

What is a UTI?

A Urinary Tract Infection (UTI) is a bacterial inflammation. It occurs when microorganisms, usually bacteria from the digestive system, penetrate the tract through the urethra opening and multiply there. Most inflammations are caused by Escherichia coli (E. coli) strains normally present in the intestine. 

The urinary tract is composed of the kidneys, the ureters, the bladder and the urethra. Inflammations can occur in any part of the urinary passage. An untreated UTI can lead to bladder and kidney damage.

What causes UTIs?

Urinary tract infections are caused by bacteria that propagate themselves and spread. 

This causes, for example:

  • Cystitis (bladder infection) 
  • Pyelonephritis (kidney infection)  
  • Urethritis (inflammation of the urethra, through which urine flows out from the bladder) 

Usually, neither bacteria nor other organisms are present in urine. UTI-causing bacteria mostly come from the anus or the vagina and subsequently reach the bladder and the kidneys. 

Women are more prone to UTI since their urethra is shorter and more easily accessible to spreading bacteria. Moreover, the meatus is closer to the anus in women.

Who are especially prone to UTI risks?

Some persons are more prone to urinary tract infections than others. The following groups are statistically more vulnerable:

Incontinent women:

Incontinent women are 2–5 times more affected by UTI than continent women.

Sexually active women:

Infections are frequent after sex, since this propitiates the spread of bacteria to the bladder. Likewise, protective measures involving diaphragms and spermicides can alter the normal bacterial environment in the urinary tract. 

Pregnant women:

Physiological changes of a hormonal or mechanical nature during pregnancy favour bacterial infections. If not treated, up to 40% of cases can result in kidney infections. Hence, a test for asymptomatic bacteriuria is indicated for all pregnant women.

Women with recurrent urinary tract infections:

Frequent UTIs are known to occur in otherwise healthy women. “Recurrent” denotes three infections a year, or two in the course of six months. 

Women after menopause:

Older women often find it increasingly hard to completely empty their bladders. Urine accumulated in the bladder enables otherwise very small populations of bacteria present to multiply and lead to infection. Frequently, however, the reasons for UTI in such cases remain unknown. 

Women suffering from urinary obstruction:

Urinary obstruction slows down the arrival of urine to the bladder and can thus lead to the development of infections. 

Women with diabetes:

Diabetes or immune system disorders raise the chances of UTI. 

Women with bladder catheters:

Catheters or tubes in the bladder often cause inflammations. 

Patients with indwelling catheters are particularly prone to the risk of UTI. Individuals unable to urinate and unconscious or those who are very unwell often require catheters for longer periods of time. Particularly aged individuals or those suffering from nervous system disorders who no longer control their bladders are even required to use catheters the rest of their lives. The bacteria developing in these catheters can infect the bladder.

What are the symptoms of UTI?

UTI can manifest itself in the following forms:

  • more frequent urge to urinate 
  • uncontrollable urge to urinate 
  • urinary incontinence (UI) 
  • pain on urination (e.g. burning sensation) 
  • strong-smelling urine 
  • varying urine volumes – sometimes more, sometimes less than usual 
  • pelvic, stomach, lower back or side pains 
  • chills, fever, sweating outbreaks 
  • pain during sexual intercourse

In elderly: none of the common symptoms might be present; but consider the following to be caused by symptomatic UTI:

  • weakening of general condition

  • higher degree of dementia

  • sudden incontinence or increased degree of incontinence

How do you get a UTI diagnosis?

Your doctor will test your symptoms, examine you thoroughly and send your urine to be tested in a laboratory for nitrite, leukocytes (white blood cells) and other parameters.

Additionally a urine culture might be done in order to confirm a positive chemical test for nitrite and leukocytes as well as doing an antibiogram to evaluate for the correct antibiotics for treatment.

What is the treatment?

UTIs are caused by bacteria and hence require treatment with antibiotics. Prescribed antibiotics must be taken throughout the prescribed duration, even if the symptoms disappear early.

How long does it last?

As a rule, the symptoms of inflammation subside after 3 to 4 days

What can be the reasons for a positive leukocyte and negative nitrite result?

At least 4h – this is often not the case in practice; most frequently found in morning urine samples

Written sources: European Urinanalysis Guidelines; Scan. J. Clin. Lab. Invest., 2000; 60:1-96: Urine should be stored in the bladder for a duration of 4-8h. This is essential to ensure sufficient nitrite accumulation in urine for detection with the dipstick method, and hence, with our test. 

Therefore, few positive nitrite tests are expected in practice if morning urine samples are not used. Since UTI somewhat increases urinary frequency, the urine does not often stay long enough in the bladder. 

ARESC Study, Naber, 2008: In practice, only 30% of female patients with bacteriuria yield positive results for nitrite.

Inhibitors – high concentrations of Vitamin C; antibiotics treatment

UTI due to non-nitrite producing bacteria or other microorganisms– very rare – the vast majority of UTIs are caused by E.coli

Low-nitrite diet – very rare

Stale urine - Further reaction of nitrite to nitrogen.

In practice, not often to be expected, since urine samples are usually processed within reasonable time to avoid such reactions.

With TENA U-test this is basically impossible since urine is taken up by the test immediately when voided by the patient and chemical reaction starts as soon as urine enters test card – no alteration – no further reaction of nitrite present in urine.

Other causes for the presence of leukocytes – e.g. another type of infection or reason for inflammation – definitely needs further examination by a doctor

MEASURE: repetition of test using morning urine sample

For TENA U-test: if leukocyte indicator does show a positive result consider this as indication for further evaluation and information to the doctor to get instructions on further measures

When do you get low-intensity colour gradations?

Leukocyte indicator:

In case that voiding of the patient did only occur within 15 minutes before pad-change and evaluation of TENA U-test results, the chemical reaction did not have enough time to fully develop the signal of a positive test result. Therefore, re-check result after 15 minutes for verification.

It should always be assumed in any event that the appearance of a violet leukocyte indicator points to the presence of the analyte and the corresponding existence of a UTI and/or inflammation.

Nitrite indicator:

The reaction of the nitrite indicator develops very fast and in an intense colour. Therefore it is not expected to get weak colour reaction as such. However strongly coloured urine  ̶ for instance, because of red beets or very low fluid intake  ̶  can lead to a darker negative signal, which however can hardly be mistaken as positive result. 

Therefore, if interpreting the test result have such interfering parameters in mind.

Can there be a delayed leukocyte indicator reaction and why?

Only in a very limited number of cases does a delayed leukocyte indicator reaction occur. 


  • relatively low leukocyte values close to or around C/O (approx. 10 leukocytes/µl); for ex., due likewise to contamination

This will lead to sparsely punctual coloration of the indicator. Consider redoing the test for clear result.

  • slow filling of the reaction chamber with urine (the leukocytes are delayed by a kind of chromatography effect and only belatedly transported to the reaction surface). 

This will lead to partial but homogeneous coloration of the indicator field. Consider redoing the test for clear result.

Why should a valid negative test result be verified again after 15 min?

Theoretically the voiding of the bladder could have happened just before the TENA U-test result is read. To allow completion of chemical reactions and therefore be absolutely sure that a valid negative test result will no longer turn into a positive result, it is recommended to check the result a second time after 15 min.

How long can TENA U-test stay in the pad applied to the patient?

TENA U-test may be kept in the pad applied to a patient until voiding of the bladder and according to normal procedures for pad changing. Technically the test may stay as long as 18 hours in a pad applied to a patient.

How much urine is necessary to make TENA U-test valid?

The chamber in the test card takes up a volume of just 200 µl. For a valid test, about 2 ml of urine is required, if the urine drops directly on or very close to the opening hole on the test card. About 10 ml is required, if the urine flows in the area around the opening hole.

Midstream urine (needed when giving a normal urine sample) is not needed when using TENA U-test – why?

A midstream sample is usually collected to avoid possible contaminating bacteria located at the entrance of the urethra. These contaminating bacteria may lead to false positive results in the urine culture.

If such bacteria are spread during application of TENA U-test, they might enter the test card. But due to the chemical conditions there, the bacteria cannot be metabolically active and do not produce nitrite. They do not therefore lead to false positive results.

If leukocytes present outside the urethra are spread into the test chamber, they may cause a scattered violet coloration, which is not to be interpreted as a positive result – as described in the leaflet.

When urine is in the bladder less than 4 hours, the bacteria don’t have time to build nitrites out of nitrate and the result is not shown as positive. How does this function with the TENA U-test?

It is the same for TENA U-test. If there is a low concentration of bacteria, the detection limit for nitrite may not be reached. All tests based on dry chemistry have this limitation. It is not just specific to TENA U-test.

When urine is in the bladder less than 4 hours, the bacteria don’t have time to build nitrites out of nitrate and the result is not shown as positive. How does this function with the TENA U-test?

It is the same for TENA U-test. If there is a low concentration of bacteria, the detection limit for nitrite may not be reached. All tests based on dry chemistry have this limitation. It is not just specific to TENA U-test.

Bacteriuria is a very common condition among long-term patients in institutions. Up till 90% of patients have bacteriuria with leukocytes in the urine but without symptoms. How does this function together with TENA U-test?

This common condition is known as asymptomatic bacteriuria, which should neither be screened for nor treated (ultimately a decision for the physician responsible). TENA U-test should only be used if a urinary tract infection is suspected due to the presence of symptoms, for example, generally poorer condition of the resident, higher incontinence, more confused resident or a high temperature. Symptoms are generally not very specific in elderly people and therefore diagnosis cannot be based on symptoms only. TENA U-test should then be used to check for both nitrite and leukocytes. If the result of TENA U-test is negative, the cause of these unspecific symptoms is not a UTI and other causes must be investigated.

Enterococcus and pseudomonas do not build nitrites – how high is the possibility of incorrect negative results and what is the risk?

E. coli is still the most frequent cause of UTI in elderly people. However, Enterococcus and Pseudomonas may also be the causative microorganisms. If a UTI is caused by one of these organisms, the leukocyte indicator will still show the presence of an inflammation in the bladder and further investigation is necessary. Since both these organisms are also known to have high antibiotic resistance, a urine culture is the most appropriate way to check which antibiotics to use. Empirical treatment most probably will fail.

What level of leukocytes is needed for TENA U-test to show a positive result?

An uncontaminated urine sample is required. This may be collected on the toilet as a midstream sample or by invasive methods like catheterisation or suprapubic aspiration.

There are test kits in the market with the appropriate agar for bacterial growth readily available on dipping devices (see pictures below). The agar plates are dipped into the urine sample and immediately transferred back to their container. The containers with the agar plates are then incubated at 37°C, the appropriate conditions for bacterial growth.

After the supplier’s recommended time of incubation the agar plates are checked for the number of colonies growing on it (see picture below). The reference pictures allow an assessment of the bacteria concentration in the tested urine sample and a decision on the possible presence of a urinary tract infection.

What is an antibiogram and how is it done?

One colony of the urine culture is taken and spread on a new agar plate. Then small discs, each containing a different antibiotic are placed on top of the agar. The antibiotic diffuses into the agar. The agar plate is again incubated at 37°C to support the growth of the applied bacteria. 

If a halo is visible around one of the discs, the bacteria are sensitive to the antibiotic. This means that this antibiotic would be suitable for treatment. If there is no halo around a disk, the bacteria are not sensitive, meaning a treatment with this antibiotic would fail. Examples of an antibiogram.


1SCA: Comparative study of time requirements for the application of TENA U-test versus traditional methods of detecting urinary tract infections. November 2013.
2Krähenbühl et al.: Evaluation of a novel in-vitro diagnostic device for the detection of urinary tract infections in diaper wearing children. Swiss Med Wkly. 2012;142:w13560.
3Nicolle et al.: Urinary Tract Infections in Long-Term Care Facilities. Infect Control Hosp Epidemiol. 1993; 14 (4); 220-225.
4Augur: Quantitative product test in Sweden and the Netherlands. 2011; Sponsor: SCA.