Research Article

Comparison of two automated urine cytometry systems: Sysmex® UF-1000i

and Beckman Coulter® DxU 850 Iris
Abderrazak Saddari1,2,3* , Said Ezrari1,3 , Mohammed Dalli4 , Elmostapha Benaissa5,6 , Yassine Ben Lahlou5,6 ,
Mostafa Elouennass5,6 , Adil Maleb1,2,3

Laboratory of Microbiology, Faculty of Medicine and Pharmacy, University Mohammed the First, Oujda, 60000, Morocco
1

2
Laboratory of Microbiology, Mohammed VI University Hospital, Oujda, 60000, Morocco
3
Laboratory of Bioresources, Biotechnology, Ethnopharmacology and Health, Faculty of Sciences, University Mohammed the First, Oujda,
60000, Morocco
4
Higher Institute of Nursing Professions and Health Techniques, Oujda, 60000, Morocco
5
Department of Bacteriology, Mohammed V Teaching Military Hospital, Rabat, 10045, Morocco
6
Epidemiology and Bacterial Resistance Research Team/BIO-INOVA Centre, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat,
10045, Morocco

Abstract
Background: Urinary tract infection, defined as the presence of bacteria or yeast in the urinary tract, is the most common
community-acquired infection after respiratory infections. The cytobacteriological examination of urine (CBEU) remains
the primary diagnostic test for urinary tract infections and is the most frequently conducted test in microbiology laboratories.
Direct examination is a crucial step of CBEU, enabling the assessment of cytology, including leukocytes and red blood cells,
as well as the identification of crystals, epithelial cells, and microorganisms when present in significant quantities. This
examination also provides preliminary results that can guide clinical decision-making. While the standard method for urine
cytology is a microscopic examination, automation offers several advantages, including standardized results with higher
repeatability, improved reproducibility, increased sample throughput, and seamless data transfer to laboratory information
systems. Objectives: This study aimed to compare the performance of two automated urine cytology systems: Sysmex UF-
1000i and the Beckman Coulter DxU 850 Iris. Methods: We described the methodology and technology underlying each
system and assessed their analytical performance. The UF-1000i uses flow cytometry for the objective characterization and
identification of particles based on forward scattering, fluorescence, and adaptive typing analysis. In contrast, the DxU-850
Iris, a urine microscopy analyzer, employs proprietary digital flow morphology technology alongside automatic particle
recognition software to isolate, identify, and characterize digital images of particles. Conclusion: Our comparison showed
that both systems performed exceptionally well, delivering results that are comparable, and, in some cases, superior to, those
obtained through the reference method of optical microscopy.
Keywords: Urinary tract infection, UF-1000i, Flow cytometry, DxU 850 Iris, Digital flow morphology

1. INTRODUCTION *Corresponding author:

Abderrazak Saddari ([email protected])
The cytobacteriological examination of urine (CBEU)
is the principal test for urinary tract infections and is by
This is an open-access article under the terms of the Creative Commons Attribution License,
far the most commonly performed test in microbiology which permits use, distribution, and reproduction in any medium, provided the original work
laboratories [1]. A critical component of this examination is properly cited.

is the direct assessment, which allows for the detection of © 2024 Bladder published by POL Scientific

leukocytes and red blood cells (RBC), as well as the potential

identification of crystals, epithelial cells, and microorganisms Received: 03 June 2024; Revision received: 15 August 2024;
Accepted: 10 October 2024; Published: 29 November 2024
in the case of significant abundance [2]. This stage also
provides preliminary results that can inform the prescriber’s How to cite this article: Saddari A, Ezrari S, Dalli M, et al. Comparison of two
clinical decisions [3]. Although microscopic examination automated urine cytometry systems: Sysmex® UF-1000i and Beckman Coulter®
remains the gold standard for urine cytology, automation DxU 850 Iris. Bladder. 2024;11(3):e21200016. DOI: 10.14440/bladder.2024.0004

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Saddari et al. UF-1000i versus DxU 850 Iris

presents a number of advantages, including standardized conditions (temperature: 15–30°C; humidity: 30–85%). The
results that enhance reproducibility compared to manual volume required for analysis is 4 mL, though manual mode
techniques, high processing capacity (over 50 samples/h), can accommodate as little as 1 mL.
and the ability to transfer data seamlessly to the laboratory’s
On the other hand, DxU 850 Iris processes urine at a rate
information system [2]. Various technologies are employed
of 101 tests/h. It features an advanced camera that identifies
in commercially available urine cytology machines, with
elements and particles based on size, shape, contrast, and
flow cytometry and imaging being the most prevalent.
texture, utilizing digital flow morphology and automatic
Microbiology laboratories must select the best-performing
particle recognition software. In addition to the basic elements
automated system based on several technical and logistical
(RBC and white blood cells [WBC], bacteria, crystals, and
criteria. The aim of our study was to compare the technical
cylinders), this analyzer can detect additional categories for
characteristics and performance of two automated urine
subclassification. It differentiates between types of crystals
cytology systems: the Sysmex UF-1000i, which uses flow
and cylinders, as well as normal and pathological cells. This
cytometry, and the Beckman Coulter DxU 850 Iris, which
device operates under standard conditions, requiring a volume
is equipped with cameras for the recognition of figurative
of only 2 mL for analysis.
elements in urine. Our findings will provide biologists and
microbiology laboratory managers with valuable insights to Table 1 represents a summary of the technical features
guide their selection of automated urine cytology systems. and specifications of each machine to facilitate a comparative
analysis of the two systems.
2. MATERIALS AND METHODS
4. DISCUSSION
The microbiology laboratory at Oujda University Hospital
processes a large number of CBEU requests every day. The microbiological diagnosis of urinary tract
Urine samples come from outpatients and are collected in infections is primarily established through CBEU,
the laboratory, as well as from patients admitted to various which is one of the most widely prescribed tests in
hospital departments. Given the high volume of CBEU medical microbiology [1,4]. This examination begins
requests, coupled with workload pressures and staff shortages, with urine cytology, a crucial step for effective treatment
our laboratory opted for automated urine cytology from and interpretation of results [2]. Traditionally, manual
the outset. We initially implemented the Sysmex UF-1000i examination under a light microscope has been the gold
system upon opening and have recently acquired the Beckman standard for urine cytology [5]. However, while this method
Coulter DxU 850 Iris. is straightforward and relatively economical, it often has
In this work, we aimed to compare the performance and disadvantages such as time consumption and variability in
technologies employed by the two automated systems. Our reliability, which can significantly depend on the experience
comparison was based on the user manuals, criteria, and data of the examiner [2,6]. Consequently, many microbiology
provided during training sessions conducted by the suppliers laboratories are increasingly adopting automated methods
of both systems, as well as our laboratory’s experience in that offer numerous advantages, including speed, precision,
analyzing urine samples. The main criteria studied include the reproducibility, and enhanced traceability. Automated systems
technology used by each analyzer, the parameters analyzed, enable direct integration with the laboratory information
the processing speed and capacity of analysis, and other systems, thereby improving traceability, interpretation, and
technical and logistical performance metrics. biological validation of results [6,7].
Over the years, several automated systems have been
3. RESULTS developed to enumerate urine components, including
leukocytes, RBC, bacteria, epithelial cells, crystals, and
The two analyzers, UF-1000i and DxU 850 Iris, utilize
cylinders [6,8]. The market is mainly dominated by two
different technologies to facilitate the cytological examination
technologies: flow cytometry, as implemented by the Sysmex
of urine (and other fluids), achieving results comparable to the
UF-1000i, and image analysis following video capture, as
reference technique in microscopy. The UF-1000i employs
utilized by the Beckman Coulter DxU 850 Iris. Both methods
flow cytometry to identify elements in urine based on size,
have demonstrated performance levels comparable to those
structure, and fluorescence, processing up to 100 samples/h.
achieved with manual microscopy [2,6,8].
This technology effectively detects RBC, leukocytes, bacteria,
and additional components such as cylinders and crystals. The UF-1000i® operates as a flow-through fluorocytometer
The analyzer demonstrates satisfactory sensitivity and designed for urinary particle analysis [2]. It quantifies
specificity, with good linearity across various levels. Optimal RBC, leukocytes, epithelial cells, bacteria, and cylinders,
performance was observed under standard environmental generating quantitative alerts for pathological cylinders,

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Table 1. Specifications and performance of the Sysmex UF‑1000i and Beckman Coulter DxU 850 Iris systems
Specifications Sysmex UF‑1000i Beckman Coulter DxU 850 Iris
Technology Flow cytometry; Digital flow morphology using automatic particle recognition
Two fluorescent reagents; software
Separate bacteria channels for better differentiation
Test parameters Erythrocytes, leukocytes, epithelial cells, cylinders, bacteria; RBC, WBC, WBC clumps, squamous epithelial cells,
Pathological cylinders, crystals, small round cells, spermatozoa, non‑squamous epithelial cells, hyaline casts, unclassified casts,
yeast, mucus crystals, bacteria, yeast, sperm, mucus
Additional categories for NA (i) Unclassified casts: Granular, cellular, waxy, broad, RBC, WBC,
subclassification epithelial cells, fatty casts
(ii) Crystals: Calcium phosphate, uric acid, calcium carbonate,
leucine, cystine, tyrosine, amorphous calcium oxalate, triple
phosphate
(iii) Non‑squamous epithelial cells: Renal epithelial, transitional
epithelial
(iv) Yeast: Budding yeast, yeast with pseudohyphae
(v) Other: RBC clumps, fat, oval fat bodies, trichomonas,
dysmorphic RBCs
Identification characteristics Size, structure, and fluorescence Size, shape, contrast, and texture
Flow rate Up to 100 samples/h Up to 101 samples/h
Capacity per rack 10 samples 10 samples
Sampler (sample changer) 50 samples (5 racks) 60 samples (6 racks)
Loading/unloading station NA Up to 14 racks
Sample volume Manual mode: 1 mL Minimum: 2.0 mL
Sampler mode: 4 mL
Intake volume 0.8 mL 1.3 mL
Dimensions/Weights 579×686×615/67.1 530×645×544/46
W × D × H (mm)/(kg)
Workstation Windows®‑driven main browser Computer with a touch‑screen monitor Windows 10
Data storage (samples) 10,000, with scatter diagrams 10,000
Operating environment Temperature: 15–30°C (Optimum: 25°C) Temperature: 18–28°C Humidity: (20–80%) non‑condensing
Humidity: 30–85%
D: Depth; H: Height, NA: Not available, RBC: Red blood cells, W: Weight, WBC: White blood cells.

yeasts, small round cells, spermatozoa, and crystals. In at the optimal focusing distance within the microscope lens’
addition, it provides data on RBC amount, facilitating the field of view. This layered arrangement also orients particles
identification of hematuria causes [2,9]. The analysis occurs orthoscopically, ensuring that asymmetric particles present
directly on the urine sample, requiring no prior preparation. their widest profile for image capture [11]. A charge-coupled
Urine particles are labeled with two specific fluorochromes device camera attached to the microscope captures 500
– one for bacteria and another for other particles – and are images per sample, with each microscopic field illuminated
then propelled by a Sheath liquid through a narrow channel by a strobe lamp. The captured images are digitized and
traversed by a laser beam. The system analyzes the scattered transmitted to an analysis processor. A sample-free image
laser light, fluorescence, and impedance to differentiate stored in memory is used to deduce the background noise of
between the various urinary constituents. Each particle each capture, thereby enhancing the morphological quality
is characterized by size, structure, and fluorescence, with of the identified particles. Subsequently, individual particles
results displayed on a connected screen as scattergrams and are isolated within each image [11,12].
histograms, providing quantitative values for each parameter
The automatic particle recognition software, a sophisticated
in units of elements/µL [2,9,10]. Figures 1 and 2 illustrate
neural network, classifies each image based on size, shape,
examples of cytological results of a urine sample analyzed
contrast, and texture characteristics. These categories include
by the UF-1000i.
RBC, WBC, WBC clusters, hyaline cylinders, unclassified
In contrast, the Beckman Coulter DxU 850 Iris first cylinders, squamous epithelial cells, non-squamous epithelial
homogenizes the sample before presenting it as a slide cells (NSE), bacteria, yeast, crystals, mucus, and semen.
sandwiched between layers of lamina. This configuration, In addition, there are 27 pre-defined subclassifications
similar to the axial hydrodynamic focusing used in some blood for identifying specific types of cylinders, crystals, NSE,
counters and flow cytometers, precisely positions the sample dysmorphic particles, and other entities [11,12]. Figure 3

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Saddari et al. UF-1000i versus DxU 850 Iris

Figure 1. Cytological results from a urine sample. The main parameters (including RBC, WBC, etc.) are presented as elements per microliter and as
elements per high-power field (HPF). The results table also includes secondary parameters, such as yeast and small round cells (SRC), expressed in
elements per microliter.
BACT: Bacteria, Cond: Conductivity, EC: Epithelial cells, Path. CAST: Pathologic cast, RBC: Red blood cells, WBC: White blood cells, X’TAL:
Crystal, YLC: Yeast.

A B

C D

Figure 2. Scattergram results for the same sample. S1 represents red blood Figure 3. Urine cytology results from the Beckman Coulter® DxU 850 Iris.
cells (RBC), while S2 denotes white blood cells (WBC). Each result is The camera captures each cell with high performance and classifies them
accompanied by a histogram displaying a Gaussian curve based on cell into several categories based on size, shape, and texture: (A) red blood
size, expressed in forward scatter (FSC). cells, (B) white blood cells, (C) yeast, and (D) squamous epithelial cells
(magnification of ×400).
presents examples of images captured by the DxU 580 Iris
value across all parameters, a high positive predictive value
in our laboratory.
for cells, and a lower positive predictive value for crystals
From a quality and performance perspective, our team and cylinders.
conducted a prior study involving 1,000 samples to verify the
effectiveness of the UF-1000i® automated system [13]. This For the DxU 850 Iris, supplier-reported data indicated
study demonstrated a strong correlation between automated a sensitivity of 96% to 100% for most parameters, with the
counts and microscope counts, with a percentage agreement exception of yeasts and non-squamous cells. Specificity
ranging from 94.2% to 96.9%, depending on the measured also exceeded 96% for the majority of parameters [11].
parameter. Specificity was satisfactory for all parameters, A comparative study by Dewulf et al. [14] on a system
exceeding 96%. While sensitivity decreased for crystals and similar to ours demonstrated that cytology systems based
cylinders, it remained satisfactory for cells (RBC, WBC, and on image and video capture were highly efficient, with very
yeasts) [13]. These results yielded a high negative predictive satisfactory results. In this study, the system’s sensitivity for

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Table 2. Analytical performance of the two analyzers UF ACKNOWLEDGMENTS

1000 and Dxu Iris
None.
System and prior Sensitivity Sensitivity for Specificity Concordance
study for cells other parameters
UF‑1000i 95–98% 55–83% 96% 94–97%
FUNDING
Maleb et al. [13] None.
DxU Iris 98–100% >80% 98% ‑
Dewulf et al. [14]
CONFLICT OF INTEREST
cell detection ranged from 98% to 100%, exceeding 80% for The authors declare no conflicts of interest.
other parameters, while specificity consistently surpassed 98%
for all measured parameters. Table 2 presents a comparison AUTHOR CONTRIBUTIONS
of the analytical performance of the two analyzers based on Conceptualization: Abderrazak Saddari, Adil Maleb
studies by Maleb et al. [13] and Dewulf et al. [14]. Investigation: Abderrazak Saddari
In other features, the two systems were comparable Methodology: Said Ezrari, Mohammed Dalli
regarding throughput (100 samples/h), data storage (10,000 Writing – original draft: Abderrazak Saddari, Adil Maleb
results), dimensions, start-up conditions, and connectivity. In Writing – review & editing: Elmostapha Benaissa, Yassine
terms of autosampler capacity, the DxU 850 Iris accommodates Ben Lahlou, Mostafa Elouennass
6 racks of 10 samples, while the UF-1000i® holds 5 racks. In
addition, the DxU 850 Iris can be equipped with a loading ETHICS APPROVAL AND CONSENT TO
station featuring a removable tray that holds up to 14 racks PARTICIPATE
of 10 samples, yielding a total autosampler capacity of Not applicable.
200 samples [10,11]. Beyond loading capacity, the DxU 850
Iris excels in recognizing pathogenic particles and offers
CONSENT FOR PUBLICATION
subclassification for several parameters, which are notable
advantages of its technology. Furthermore, its artificial The study was conducted on anonymous biological samples.
intelligence allows the system to continuously learn from user It does not concern any personal data that could directly or
corrections and the potential addition of new parameters and indirectly identify a specific person.
recognizable particles [11,12,14].
AVAILABILITY OF DATA
Despite the significant contributions of this study in
comparing the two systems and their respective technologies, All the data used are available directly in the article or through
several limitations should be considered. Conducting a the references cited.
quality-controlled verification of both methods would
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