Prostatitis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Prostatitis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Prostatitis]]
{{CMG}} {{AE}} {{Maliha}}, {{USAMA}}
{{CMG}} {{AE}} {{Maliha}}, {{USAMA}}
==Overview==
==Overview==
Prostatitis must be differentiated from various other diseases on the basis of symptoms like [[dysuria]]. The differential diagnosis includes [[acute cystitis]], [[benign prostatic hyperplasia]], [[prostatic abscess]], [[bladder cancer]], [[urinary tract stones]], and a foreign body within the [[urinary tract]].<ref name="pmid20704171">{{cite journal| author=Sharp VJ, Takacs EB, Powell CR| title=Prostatitis: diagnosis and treatment. | journal=Am Fam Physician | year= 2010 | volume= 82 | issue= 4 | pages= 397-406 | pmid=20704171 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20704171  }} </ref>
*Prostatisis must be differentiated from other diseases that cause [[Abdominal pain|lower abdominal pain]] and [[fever]] like [[appendicitis]], [[diverticulitis]], [[inflammatory bowel disease]], [[cystitis]], [[Colorectal cancer]], and [[endometritis]].<ref name="pmid17573742">{{cite journal| author=Laurell H, Hansson LE, Gunnarsson U| title=Acute diverticulitis--clinical presentation and differential diagnostics. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 6 | pages= 496-501; discussion 501-2 | pmid=17573742 | doi=10.1111/j.1463-1318.2006.01162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17573742  }} </ref><ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref><ref name="pmid8596552">{{cite journal| author=Hanauer SB| title=Inflammatory bowel disease. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 13 | pages= 841-8 | pmid=8596552 | doi=10.1056/NEJM199603283341307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8596552  }} </ref><ref name="hhh">Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016</ref><ref name="nlm">Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref>
 
{| class="wikitable"
! colspan="2" rowspan="2" |Diseases
! colspan="2" |Symptoms
! colspan="3" |Signs
! colspan="2" |Diagnosis
! rowspan="2" |Comments
|-
!Abdominal pain
!Bowel habits
!Rebound tenderness
!Guarding
!Genitourinary signs
!Lab findings
!Imaging
|-
| rowspan="5" |GI diseases
|[[Colon carcinoma|Colorectal cancer]]
|LLQ
|Constipation
 
| -
| -
| -
|
* Serum [[carcino-embryogenic antigen]] 
* Low Vit b12
* [[Hypercalcemia]]
|CT scan, x-ray and MRI used to show [[metastasis]]
|
|-
|[[Inflammatory bowel disease]]
|LLQ
|Bloody diarrhea
|<nowiki>-</nowiki>
| -
| -
|
* Leukocytosis
|
|[[Colonoscopy]] and tissue sampling are recommended for differentiating between [[Crohn's disease]] and [[ulcerative colitis]].
|-
|[[Diverticulitis]]
|LLQ
|[[Constipation]]
Or
 
[[Diarrhea]]
| -
| +
|<nowiki>+ </nowiki>
|
* [[Leukocytosis]]
|CT scan shows evidence of [[inflammation]]
|
|-
|[[Appendicitis]]
|LLQ / RRQ
|Constipation
| +
| +
| -
|
* [[Leukocytosis]]
|Ultrasound shows evidence of [[inflammation]]
|[[Nausea and vomiting|Nausea & vomiting]],[[decreased appetite]]
|-
|[[Strangulated hernia]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* No specific tests
|
* CT scan used to detect the [[hernia]] and to show if it is single or multiple
|
|-
| rowspan="3" |Gentiourinary diseases
|[[Cystitis]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Suprapubic tenderness
|
* [[Pyuria]]
* Presence of [[nitrites]] and leukocyte estrase
|
* X ray is done to probe the suspicion of emphysematous cystitis.
* CT scan shows gas in the [[Urinary bladder|bladder]] in cases of emphysematous cystitis.
|
|-
|[[Prostatitis]]
|LLQ
 
Groin pain
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Tender and enlarged
|
* Serum [[Prostate specific antigen|PSA]] elevated
* [[Leukocytosis]]
* Elevated [[C-reactive protein|CRP]]
|
* CT scan shows [[edema]] and enlarged [[prostate]]
* [[Abscess]] may be observed
|
|-
|[[Pelvic inflammatory disease]]
|Bilateral
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| -
|
* Purulent vaginal discharge
|
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID.
|[[Transvaginal ultrasound|Transvaginal utrasonography]]
|
|-
| rowspan="2" |Gynecological diseases
|[[Endometritis]]
|LLQ
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* No specific tests
|
* Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses
|
* Vaginal discharge
 
* Vaginal bleeding
|-
|[[Salpingitis]]
|LLQ/ RLQ
|
| +/-
| +/-
|
|
* Leukocytosis
|Pelvic ultrasound
|
* Vaginal discharge
|}
 
 
*Prostatitis must be differentiated from various other diseases on the basis of symptoms like [[dysuria]]. The differential diagnosis includes [[acute cystitis]], [[benign prostatic hyperplasia]], [[prostatic abscess]], [[bladder cancer]], [[urinary tract stones]], and a foreign body within the [[urinary tract]].<ref name="pmid20704171">{{cite journal| author=Sharp VJ, Takacs EB, Powell CR| title=Prostatitis: diagnosis and treatment. | journal=Am Fam Physician | year= 2010 | volume= 82 | issue= 4 | pages= 397-406 | pmid=20704171 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20704171  }} </ref>


==Differentiating Prostatitis from other Diseases==
==Differentiating Prostatitis from other Diseases==
Line 29: Line 186:
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cystitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cystitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Bladder inflammation, Features with increased frequency and urgency, [[dysuria]], and suprapubic pain. Is more common among women. [[E.coli]] is the most common pathogen<ref>{{Cite journal
| style="padding: 5px 5px; background: #F5F5F5;" | Bladder [[inflammation]], features with increased [[frequency]] and [[urgency]], [[dysuria]], and suprapubic pain. Is more common among women. [[E.coli]] is the most common pathogen<ref>{{Cite journal
  | author = [[Stephen Bent]], [[Brahmajee K. Nallamothu]], [[David L. Simel]], [[Stephan D. Fihn]] & [[Sanjay Saint]]
  | author = [[Stephen Bent]], [[Brahmajee K. Nallamothu]], [[David L. Simel]], [[Stephan D. Fihn]] & [[Sanjay Saint]]
  | title = Does this woman have an acute uncomplicated urinary tract infection?
  | title = Does this woman have an acute uncomplicated urinary tract infection?
Line 73: Line 230:
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Urethritis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Urethritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |infection of the urethra,causes dysuria and urethral discharge<ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |Infection of the [[urethra]],causes [[dysuria]] and [[urethral discharge]]<ref name="pmid8801649">{{cite journal |vauthors=Taylor-Robinson D |title=The history of nongonococcal urethritis. Thomas Parran Award Lecture |journal=Sex Transm Dis |volume=23 |issue=1 |pages=86–91 |year=1996 |pmid=8801649 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[vaginitis|Bacterial vulvovaginitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with dysuria and pruritus, Vaginal discharge and odor are almost always present, caused by [[Gardnerella]] species<ref>{{Cite journal
| author = [[Daniel V. Landers]], [[Harold C. Wiesenfeld]], [[R. Phillip Heine]], [[Marijane A. Krohn]] & [[Sharon L. Hillier]]
| title = Predictive value of the clinical diagnosis of lower genital tract infection in women
| journal = [[American journal of obstetrics and gynecology]]
| volume = 190
| issue = 4
| pages = 1004–1010
| year = 2004
| month = April
| doi = 10.1016/j.ajog.2004.02.015
| pmid = 15118630
}}</ref>.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cervicitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Often asymptomatic,some women have an abnormal vaginal discharge and vaginal bleeding (especially after sexual intercourse)<ref>{{Cite journal
| author = [[Kimberly A. Workowski]] & [[Gail A. Bolan]]
| title = Sexually transmitted diseases treatment guidelines, 2015
| journal = [[MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control]]
| volume = 64
| issue = RR-03
| pages = 1–137
| year = 2015
| month = June
| pmid = 26042815
}}</ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Prostatitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Prostatitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |bacterial infection of the prostate,causes discomfort during ejaculation<ref>{{Cite journal
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacterial infection]] of the prostate,causes discomfort during ejaculation<ref>{{Cite journal
  | author = [[Felix Millan-Rodriguez]], [[J. Palou]], [[Anna Bujons-Tur]], [[Mireia Musquera-Felip]], [[Carlota Sevilla-Cecilia]], [[Marc Serrallach-Orejas]], [[Carlos Baez-Angles]] & [[Humberto Villavicencio-Mavrich]]
  | author = [[Felix Millan-Rodriguez]], [[J. Palou]], [[Anna Bujons-Tur]], [[Mireia Musquera-Felip]], [[Carlota Sevilla-Cecilia]], [[Marc Serrallach-Orejas]], [[Carlos Baez-Angles]] & [[Humberto Villavicencio-Mavrich]]
  | title = Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract
  | title = Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract
Line 117: Line 247:
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epididymo-orchitis|Epididymitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epididymo-orchitis|Epididymitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms([[dysuria]] and frequency)<ref>{{Cite journal
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[scrotal pain]] and [[swelling]] accompanied by fever and lower urinary tract irritation symptoms([[dysuria]] and frequency)<ref>{{Cite journal
  | author = [[A. Stewart]], [[S. S. Ubee]] & [[H. Davies]]
  | author = [[A. Stewart]], [[S. S. Ubee]] & [[H. Davies]]
  | title = Epididymo-orchitis
  | title = Epididymo-orchitis
Line 137: Line 267:


[[Category:Disease]]
[[Category:Disease]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Urology]]

Latest revision as of 23:50, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Diseases Symptoms Signs Diagnosis Comments
Abdominal pain Bowel habits Rebound tenderness Guarding Genitourinary signs Lab findings Imaging
GI diseases Colorectal cancer LLQ Constipation - - - CT scan, x-ray and MRI used to show metastasis
Inflammatory bowel disease LLQ Bloody diarrhea - - -
  • Leukocytosis
 Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis.
Diverticulitis LLQ Constipation

Or

Diarrhea

- + + CT scan shows evidence of inflammation
Appendicitis LLQ / RRQ Constipation + + - Ultrasound shows evidence of inflammation Nausea & vomiting,decreased appetite
Strangulated hernia LLQ - - - -
  • No specific tests
  • CT scan used to detect the hernia and to show if it is single or multiple
Gentiourinary diseases Cystitis LLQ - + -
  • Suprapubic tenderness
  • X ray is done to probe the suspicion of emphysematous cystitis.
  • CT scan shows gas in the bladder in cases of emphysematous cystitis.
Prostatitis LLQ

Groin pain

- - -
  • Tender and enlarged
Pelvic inflammatory disease Bilateral - + -
  • Purulent vaginal discharge
 Transvaginal utrasonography
Gynecological diseases Endometritis LLQ - + - +
  • No specific tests
  • Ultrasound is helpful to rule out other differential diagnosis such as pelvic abscess, thrombosis and masses
  • Vaginal discharge
  • Vaginal bleeding
Salpingitis LLQ/ RLQ +/- +/-
  • Leukocytosis
 Pelvic ultrasound
  • Vaginal discharge


Differentiating Prostatitis from other Diseases

Prostatitis must be differentiated from:[7]

Differential Diagnosis on the basis of Urinary Symptoms

Prostatitis can be differentiated from other diseases that cause lower urinary tract irritation symptoms, such as: dysuria, urgency and frequency in addition to urethral discharge , the differential list include: urethritis, pyelonephritis, cystitis, cervicitis, vulvovaginitis, epididimitis and syphilis.[8][9][10][11]


Disease Findings
Cystitis Bladder inflammation, features with increased frequency and urgency, dysuria, and suprapubic pain. Is more common among women. E.coli is the most common pathogen[12][13][14][15].
Urethritis Infection of the urethra,causes dysuria and urethral discharge[10][16][17]
Prostatitis Bacterial infection of the prostate,causes discomfort during ejaculation[18]
Epididymitis Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms(dysuria and frequency)[19].
Syphilis Presents with generalized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic. It is classically described as 1) non-pruritic bilateral symmetrical mucocutaneous rash; 2) non-tender regional lymphadenopathy; 3) condylomata lata; and 4) patchy alopecia.[9]

References

  1. ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  2. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  3. ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  4. ↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  5. ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  6. ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
  7. ↑ 7.0 7.1 Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.
  8. ↑ Kurowski K (1998). "The woman with dysuria". Am Fam Physician. 57 (9): 2155–64, 2169–70. PMID 9606306.
  9. ↑ 9.0 9.1 Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
  10. ↑ 10.0 10.1 Taylor-Robinson D (1996). "The history of nongonococcal urethritis. Thomas Parran Award Lecture". Sex Transm Dis. 23 (1): 86–91. PMID 8801649.
  11. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  12. ↑ 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)
  13. ↑ 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)
  14. ↑ 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)
  15. ↑ 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.
  16. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  17. ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
  18. ↑ 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)
  19. ↑ A. Stewart, S. S. Ubee & H. Davies (2011). "Epididymo-orchitis". BMJ (Clinical research ed.). 342: d1543. PMID 21490048.
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