Differentials
Urogenital fistula (urethrovaginal, ureterovaginal, uterovaginal, and vesicovaginal fistula)
SIGNS / SYMPTOMS
Continuous urine loss with no association to other symptoms or timing.
INVESTIGATIONS
After performing thorough pelvic examination - as well as speculum examination for direct visualisation of vaginal pooling and/or fistulous tract - cystoscopy, voiding cystourethrogram, intravenous pyelogram, or retrograde pyelogram may be performed to evaluate and identify location of suspected urogenital fistula.
Ectopic ureter
SIGNS / SYMPTOMS
Difficult to differentiate clinically.
Presentation is variable dependent on location of ureteral orifice.
INVESTIGATIONS
Total incontinence due to ectopic ureter or urethrocoele may be visualised during physical examination or cystourethroscopy. Intravenous pyelogram can show aberrant anatomy.
Urinary tract infection
SIGNS / SYMPTOMS
Frequency and burning with urination. May see haematuria.
INVESTIGATIONS
Urinalysis may show WBCs, red blood cells, nitrites.
Urine culture may be positive.
Atrophic urethritis/vaginitis
SIGNS / SYMPTOMS
Frequency and irritation with voiding.
INVESTIGATIONS
Shift in mucosal maturation index from superficial cells to a predominance of parabasal cells.
May see increase in vaginal pH.
Pregnancy
SIGNS / SYMPTOMS
Frequency without irritation. May include incontinence.
Low perceived bladder volume.
INVESTIGATIONS
Urine human chorionic gonadotrophin (hCG)-positive.
Neurogenic bladder
SIGNS / SYMPTOMS
Clinical features of the underlying neurological condition.
Bulbocavernosus and anal wink reflexes and perineal sensation may be altered.
INVESTIGATIONS
Post-void residual: may be increased.
Urodynamics: may show detrusor overactivity, underactivity, acontractility; bladder outlet obstruction; detrusor sphincter dyssynergia; high urethral resistance.
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