Differentials
Overactive bladder
SIGNS / SYMPTOMS
Frequent urge to urinate with possible incontinence and nocturia.
INVESTIGATIONS
Bladder ultrasound with low postvoid residuals.
Abnormal pressure flow studies.
Acute prostatitis
SIGNS / SYMPTOMS
Fever, suprapubic or low back pain, tender, enlarged prostate gland on rectal exam is more consistent with prostatitis.
INVESTIGATIONS
Elevation of white count.
Abnormal urinary sediment.
Possible elevation of prostate-specific antigen.
Chronic prostatitis
SIGNS / SYMPTOMS
History of pelvic pain lasting for at least 3 months, often localized around the prostate. Tender, enlarged prostate gland on rectal exam is more consistent with prostatitis.
INVESTIGATIONS
Positive urine culture indicates chronic bacterial prostatitis.
Possible elevation of prostate-specific antigen.
Prostate cancer
SIGNS / SYMPTOMS
Abnormal digital rectal exam with prostate nodules or asymmetry is more consistent with prostate cancer.
INVESTIGATIONS
Elevated prostate-specific antigen (PSA) for age.
Low free PSA.
Increased PSA velocity greater than 0.75 nanograms/mL/year.
Malignant cells detected in one or more biopsy specimens. MRI of the prostate (MRI of the pelvis with and without contrast).
Urinary tract infection (UTI)
SIGNS / SYMPTOMS
Presence of fever, dysuria, suprapubic or low back pain is more consistent with UTI.
INVESTIGATIONS
Abnormal urinalysis with pyuria and positive urinary culture.
Bladder cancer
SIGNS / SYMPTOMS
Hematuria, suprapubic pain, bladder spasms with abnormal voiding, history of tobacco abuse, unknown major risk factor is more consistent with bladder cancer.
INVESTIGATIONS
Microscopic hematuria on urinalysis.
Abnormal findings on cystoscopy.
Abnormal bladder mass effect with invasion on imaging studies such as ultrasound and CT.
Neurogenic bladder
SIGNS / SYMPTOMS
Storage abnormality in patients with involuntary bladder contractions.
Usually seen in patients with vascular disease, Parkinson disease, multiple sclerosis, or diabetes mellitus with neuropathy.
INVESTIGATIONS
Abnormal urodynamic studies with increased residual volume or catheterization following voiding or on ultrasound.
Bladder underactivity/acontractile detrusor
SIGNS / SYMPTOMS
Storage abnormalities seen in patients with urinary retention or incomplete bladder emptying.
Usually seen in patients of advanced age and those with diabetes mellitus or a long-standing obstruction.
INVESTIGATIONS
Abnormal uroflowmetry, elevated postvoid residual with abnormal urodynamic studies with diminished or absent detrusor contraction on attempted void.
Urethral stricture
SIGNS / SYMPTOMS
History of straddle injury or prior urologic surgery with obstructive symptoms is more consistent with urethral stricture.
INVESTIGATIONS
Abnormal retrograde urethrogram, cystoscopy, diminished peak flow on uroflowmetry.
Use of this content is subject to our disclaimer