Differentials
Benign prostatic hyperplasia (BPH)
SIGNS / SYMPTOMS
Typically presents with a gradual reduction in urinary flow, hesitancy, frequency, and nocturia. May also present with acute retention of urine.
INVESTIGATIONS
Clinical diagnosis with negative urinalysis. Histological examination of the prostate reveals BPH.
Prostate cancer
SIGNS / SYMPTOMS
May present with similar symptoms to BPH (e.g., reduced urinary flow, frequency, and nocturia). Advanced cases may present with signs of metastatic disease, including bone pain.
INVESTIGATIONS
Serum prostate-specific antigen elevated and may be extremely high in advanced disease.
Histological examination of the prostate reveals prostatic carcinoma.
Urinary tract infection (UTI)
SIGNS / SYMPTOMS
Patients usually do not have symptoms of bladder outflow obstruction unless they have coexisting BPH or prostatic malignancy.
INVESTIGATIONS
None. Urine cultures may be positive in acute prostatitis and UTIs.
Bladder cancer
SIGNS / SYMPTOMS
Typically presents with haematuria (either frank or microscopic). Patients may also complain of dysuria and urinary frequency.
INVESTIGATIONS
Urinalysis typically with haematuria, though may be negative (e.g., diluted urine sample).
Cystoscopic examination of the bladder demonstrates the presence of a tumour.
Colorectal cancer
SIGNS / SYMPTOMS
Typically presents with a change in bowel habit and, in some patients, rectal bleeding. Patients may also present with weight loss.
INVESTIGATIONS
Endoscopic examination of the rectum and colon demonstrates the presence of a tumour.
The tumour may also be demonstrated on imaging (e.g., barium enema).
Epididymitis/orchitis
SIGNS / SYMPTOMS
Typically presents with scrotal/testicular pain and symptoms of dysuria and frequency.
INVESTIGATIONS
Clinical diagnosis. Colour duplex ultrasonography may show enlarged and hyperaemic epididymis.
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