Clinical utility of dipstick urinalysis in assessing fitness to dive in military divers, submariners, and hyperbaric personnel

Abstract

Introduction: Routine dipstick urinalysis is part of many dive medical assessment protocols. However, this has a significant chance of producing false-positive or false-negative results in asymptomatic and healthy individuals. Studies evaluating the value of urinalysis in dive medical assessments are limited. Methods: All results from urinalysis as part of dive medical assessments of divers, submarines, and hyperbaric personnel of the Royal Netherlands Navy from 2013 to 2023 were included in this study. Additionally, any information regarding additional testing, referral, or test results concerning the aforementioned was collected. Results: There were 5,899 assessments, resulting in 46 (0.8%) positive dipstick urinalysis results, predominantly microscopic haematuria. Females were significantly overrepresented, and revisions resulted in significantly more positive test results than initial assessments. Lastly, almost half of the cases were deemed fit to dive, while the other half were regarded as temporarily unfit. These cases required additional testing, and a urologist was consulted three times. Conclusions: To our knowledge, this is the most extensive study evaluating urinalysis in dive medical assessments. In our military population, the incidence of positive test results is very low, and there have not been clinically relevant results over a period of 10 years. Therefore, routinely assessing urine in asymptomatic healthy military candidates is not cost-effective or efficacious. The authors advise taking a thorough history for fitness to dive assessments and only analysing urine when a clinical indication is present.