Differentials
Benign prostatic hypertrophy (BPH)
SIGNS / SYMPTOMS
Symptoms of obstructed urine flow may occur.
UTI symptoms are uncommon unless obstruction leads to UTI development.
INVESTIGATIONS
Elevated PSA may suggest presence of hyperplasia.
An enlarged and firm prostate identified on digital rectal exam helps to confirm the diagnosis.
Prostatitis
SIGNS / SYMPTOMS
Most commonly presents with rectal pain and symptoms of obstructed urine flow.
Dysuria and urinary frequency may occur.
INVESTIGATIONS
A tender and boggy prostate on digital rectal exam suggests prostatitis.
Pyelonephritis
SIGNS / SYMPTOMS
Often a complication of UTI, but can occur without history of UTI.
May be indicated by costovertebral angle pain with tenderness on examination.
INVESTIGATIONS
Presence of WBC casts on U/A indicates pyelonephritis.
Urinary tract stones
SIGNS / SYMPTOMS
Urinary tract stones may result in damage of the urinary epithelium and consequently dysuria; however, they also typically cause pain.
A past medical history of stone formation can help identify risk.
INVESTIGATIONS
Intravenous urogram and CT scan both will identify the presence of a urinary tract stone, but CT scan is more accurate and does not require use of intravenous contrast.
Gonococcal urethritis
SIGNS / SYMPTOMS
New or multiple sexual partners implies risk.
Frequency and urgency of urination as well as fever are often absent.
The presence of purulent urethral discharge is more suggestive of gonorrhea than UTI.[5]
Occurs more commonly in young men.
INVESTIGATIONS
A gonococcal DNA intraurethral probe accurately identifies the presence of gonorrhea.
Chlamydia urethritis
SIGNS / SYMPTOMS
New or multiple sexual partners implies risk.
Frequency and urgency of urination as well as fever are often absent.
Occurs more commonly in young men.
INVESTIGATIONS
Urine culture will be sterile.
A chlamydia DNA intraurethral probe accurately identifies the presence of chlamydia.
Bladder cancer
INVESTIGATIONS
Cystoscopy with confirmatory tissue biopsy determines the presence of bladder cancer.
Prostate cancer
SIGNS / SYMPTOMS
Symptoms of obstructed urine flow may occur.
UTI symptoms are uncommon unless obstruction leads to UTI development.
INVESTIGATIONS
Elevated PSA suggests presence of malignancy.
Tissue biopsy confirms the diagnosis.
Renal cancer
INVESTIGATIONS
CT scan will identify the presence of a renal mass.
Pathological analysis, typically at the time of surgical removal, confirms the diagnosis.
Epididymitis
SIGNS / SYMPTOMS
Most often presents with scrotal pain and is not associated with dysuria, urgency, or frequency.
Tender, swollen epididymis.
INVESTIGATIONS
U/A and culture are negative in isolated epididymitis, but UTI may be present additionally.
Reactive arthritis
SIGNS / SYMPTOMS
Symptoms unrelated to the urinary tract may be present, such as arthralgia, back pain, or ocular symptoms.
INVESTIGATIONS
Urine culture will be sterile.
Blood testing may reveal hypergammaglobulinemia and a positive HLA-B27 tissue antigen.
Behcet syndrome
SIGNS / SYMPTOMS
Symptoms unrelated to the urinary tract may be present, such as arthralgia, back pain, ocular symptoms, and oral ulcers.
INVESTIGATIONS
Urine culture will be sterile.
Seems to have relationship to HLA-B5 antigen.
A positive pathergy test and the presence of serum immune complexes may aid in diagnosis.
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