Effectiveness of educational video versus standard verbal instruction on midstream urine collection among elective urology patients: a randomized controlled trial

Accurate midstream urine (MSU) collection is essential to minimise contamination and support correct diagnosis of urinary tract infection, yet contamination remains common despite routine verbal instruction. Persistent contamination can cause misdiagnosis, unnecessary antibiotics and delays before endourological procedures. This trial evaluated whether an educational video improves MSU collection compared with standard verbal instruction among elective urology patients. This prospective randomised controlled trial included adults admitted for elective urology surgery at a tertiary public hospital in Selangor, Malaysia (21 January–31 March 2025). Eligible patients (> 18 years, any sex, able to consent, English or Malay-speaking) were randomised 1:1 to standard verbal or educational video instruction on MSU collection. All participants completed a pre-intervention questionnaire, collected two urine samples (urinalysis and culture), and then completed a post-collection questionnaire. The primary outcome was urine sample contamination, defined as mixed growth of > 2 species or growth of typical skin/perineal/vaginal flora. Secondary outcomes were urinalysis indices, participant-reported knowledge and satisfaction, and a six-step correct practice score (0–6). Categorical outcomes were compared using Pearson’s chi-square tests; practice scores were compared using the Mann–Whitney U test. A total of 150 patients were randomised (75 per group; mean age 56.6 ± 13.8 years; 74.7% with comorbidities). Contamination was lower in the video than verbal group (24.0% vs. 38.7%; χ²=3.75, P = 0.053). Participants with diabetes had higher contamination than those without (42.9% vs. 24.5%; P = 0.019). Correct practice was high overall, but 88.0% of the video group versus 76.0% of the verbal group achieved a perfect score of 6; median (IQR) was 6.0 (0.0) in both groups, with a significant difference favouring video (z = − 2.101, P = 0.036). Educational video instruction improved adherence to correct MSU collection steps and showed a non-significant trend towards reduced contamination compared with standard verbal instruction.