Urethral cancer differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [6], Vindhya BellamKonda, M.B.B.S [7]
Overview
Urethral cancer must be differentiated from bladder cancer, cervical cancer, bladder stones, ureteral stones, cystitis, neurogenic bladder, and urethritis.
Differentiation
Urethral cancer must be differentiated from other diseases that cause lower urinary tract irritation symptoms (e.g., dysuria, urgency and frequency in addition to urethral discharge); these include Bladder cancer, Cervical cancer, urethritis, Bladder stones, cystitis, urethrolithiasis, Neurogenic bladder, cervicitis, vulvovaginitis, and epididymitis.[1][2][3][4][5][6][7][8][9][10][11]
| Diseases | Symptoms | Physical Examination | Diagnostic tests | Past medical history | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hematuria | Pyuria | Frequency | Urgency | Dysuria | Weak urine stream | Mass | Fever | Tenderness | Discharge | Inguinal Lymphadenopathy | Urinalysis | Urine Culture | Gold Standard | ||
| Urethral Cancer | + | – | +/– | +/– | +/– | + | + | – | – | – | – | Malignant cells
RBC |
– | Biopsy |
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| Bladder cancer | + | – | +/– | +/– | – | – | +/– | – | – | – | – | Malignant cells
RBC |
– | Biopsy |
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| Cervical cancer | – | – | +/– | +/– | – | – | +/– | – | – | – | – | – | – | Biopsy |
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| Bladder stones | + | – | + | +/– | +/– | – | – | – | – | – | – | RBC | – | CT scan without contrast |
Common risk factors in the development of nephrolithiasis include:
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| Ureterolithiasis | + | – | + | + | +/– | – | – | – | – | – | – | RBC | – | CT scan without contrast | Same as bladder cancer |
| Neurogenic bladder | – | – | +/– | +/– | – | – | – | – | – | – | – | – | – | Urodynamic study (UDS) |
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| Urethritis | – | + | – | – | + | +/– | – | + | – | Urethral discharge | + |
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– | Gram stain & mucoid or purulent discharge |
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| Cystitis | + | + | + | + | + | – | – | + | Suprapubic | – | + |
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>100,000CFU/mL | Urine culture |
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| Diseases | Symptoms | Physical Examination | Diagnostic tests | Past medical history | |||||||||||
| Hematuria | Pyuria | Frequency | Urgency | Dysuria | Weak urine stream | Mass | Fever | Tenderness | Discharge | Inguinal Lymphadenopathy | Urinalysis | Urine Culture | Gold Standard | ||
| Vulvovagintis | – | – | – | – | + | + | – | Vaginal discharge | + | – | – | Gram stain & culture of discharge |
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| Cervicitis | – | + | – | – | + | + | Cervical | Endocervical exudate | – | – | – | Culture for gonococcal cervicitis |
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| Epididymitis | + | – | + | + | + | + | Testicular & suprapubic | +/– urethral discharge | + |
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+ | Culture |
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References
- ↑ Stephen Bent, Brahmajee K. Nallamothu, David L. Simel, Stephan D. Fihn & Sanjay Saint (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA. 287 (20): 2701–2710. PMID 12020306. Unknown parameter
|month=ignored (help) - ↑ W. E. Stamm (1981). "Etiology and management of the acute urethral syndrome". Sexually transmitted diseases. 8 (3): 235–238. PMID 7292216. Unknown parameter
|month=ignored (help) - ↑ W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes (1980). "Causes of the acute urethral syndrome in women". The New England journal of medicine. 303 (8): 409–415. doi:10.1056/NEJM198008213030801. PMID 6993946. Unknown parameter
|month=ignored (help) - ↑ Leonie G. M. Giesen, Grainne Cousins, Borislav D. Dimitrov, Floris A. van de Laar & Tom Fahey (2010). "Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs". BMC family practice. 11: 78. doi:10.1186/1471-2296-11-78. PMID 20969801.
- ↑ Taylor-Robinson D (1996). "The history of nongonococcal urethritis. Thomas Parran Award Lecture". Sex Transm Dis. 23 (1): 86–91. PMID 8801649.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
- ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
- ↑ Daniel V. Landers, Harold C. Wiesenfeld, R. Phillip Heine, Marijane A. Krohn & Sharon L. Hillier (2004). "Predictive value of the clinical diagnosis of lower genital tract infection in women". American journal of obstetrics and gynecology. 190 (4): 1004–1010. doi:10.1016/j.ajog.2004.02.015. PMID 15118630. Unknown parameter
|month=ignored (help) - ↑ Felix Millan-Rodriguez, J. Palou, Anna Bujons-Tur, Mireia Musquera-Felip, Carlota Sevilla-Cecilia, Marc Serrallach-Orejas, Carlos Baez-Angles & Humberto Villavicencio-Mavrich (2006). "Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract". World journal of urology. 24 (1): 45–50. doi:10.1007/s00345-005-0040-4. PMID 16437219. Unknown parameter
|month=ignored (help) - ↑ Kim TH, Kim SY, Moon KC, Lee J, Cho JY, Kim SH (April 2017). "Clear Cell Adenocarcinoma of the Urethra in Women: Distinctive MRI Findings for Differentiation From Nonadenocarcinoma and Non-Clear Cell Adenocarcinoma of the Urethra". AJR Am J Roentgenol. 208 (4): 805–811. doi:10.2214/AJR.16.16929. PMID 28140610.
- ↑ Cantiello F, Cicione A, Salonia A, Autorino R, Tucci L, Madeo I, Damiano R (May 2013). "Periurethral fibrosis secondary to prostatic inflammation causing lower urinary tract symptoms: a prospective cohort study". Urology. 81 (5): 1018–23. doi:10.1016/j.urology.2013.01.053. PMID 23608423.
- ↑ [1] American Cancer Society
- ↑ [2]
- ↑ [3]
- ↑ [4]
- ↑ Kim JJ, Burger EA, Regan C, Sy S. PMID 30212064. Missing or empty
|title=(help) - ↑ Tatar O, Thompson E, Naz A, Perez S, Shapiro GK, Wade K, Zimet G, Gilca V, Janda M, Kahn J, Daley E, Rosberger Z (November 2018). "Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis". Prev Med. 116: 40–50. doi:10.1016/j.ypmed.2018.08.034. PMID 30172799.