Cystitis differential diagnosis

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

Cystitis must be differentiated from other causes of dysuria such as acute pyelonephritis, urethritis, prostatitis, vulvovaginitis, urethral strictures or diverticula, benign prostatic hyperplasia and neoplasms such as renal cell carcinoma and cancers of the bladder, prostate, and penis. It must also be differentiated from sexually transmitted diseases such as syphilis.

Differential Diagnosis

• Cystitis must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, diverticulitis, inflammatory bowel disease, colorectal cancer, and endometritis.

Diseases		Symptoms		Signs			Diagnosis		Other Features
		Abdominal pain	Bowel habits	Rebound tenderness	Guarding	Genitourinary signs	Lab findings	Imaging
GI diseases	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	-	-	-	Leukocytosis		Colonoscopy and tissue sampling are recommended for differentiating between Crohn's disease and ulcerative colitis.
	Diverticulitis	LLQ	Constipation Or Diarrhea	-	+	+	Leukocytosis	CT scan shows evidence of inflammation
	Appendicitis	LLQ / RRQ	Constipation	+	+	-	Leukocytosis	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	Pyuria Presence of nitrites and leukocyte estrase	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	Serum PSA elevated Leukocytosis Elevated CRP	CT scan shows edema and enlarged prostate Abscess may be observed
	Pelvic inflammatory disease	Bilateral	-	+	-	Purulent vaginal discharge	Nucleic acid amplification tests is the best laboratory test for PID.	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

• The differential diagnoses of Cystitis include:

• Acute pyelonephritis
• Ureteritis
• Urethritis
• Prostatitis
• Vulvovaginitis
• Cervicitis
• Urethral strictures or diverticula
• Benign prostatic hyperplasia
• Syphilis
• Genital Herpes
• Neoplasms such as renal cell carcinoma and cancers of the bladder, prostate, and penis

Cystitis must also be differentiated from sexually transmitted diseases, such as syphilis.

Cystitis can be differentiated from other diseases that cause lower urinary tract irritation symptoms, such as: dysuria, urgency and frequency in addition to urethral dyscharge , the differential list include: urethritis, cervicitis, vulvovaginitis, epididimitis, prostatitis , and syphilis.

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.
Urethritis	infection of the urethra,causes dysuria and urethral discharge
Bacterial vulvovaginitis	Presents with dysuria and pruritus, Vaginal discharge and odor are almost always present, caused by Gardnerella species.
Cervicitis	Often asymptomatic,some women have an abnormal vaginal discharge and vaginal bleeding (especially after sexual intercourse)
Prostatitis	bacterial infection of the prostate,causes discomfort during ejaculation
Epididymitis	Presents with scrotal pain and swelling accompanied by fever and lower urinary tract irritation symptoms(dysuria and frequency).
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.