Urethral cancer differential diagnosis: Difference between revisions

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! colspan="3" |<small>Diagnostic tests</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Hematuria</small>
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:* White female
:* White female
:* Age 60
:* Age 60
| align="center" style="background:#F5F5F5;" + |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bladder cancer]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bladder cancer]]
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* Personal history of cancer in the [[urinary tract]]
* Personal history of cancer in the [[urinary tract]]
* [[Congenital]] bladder anomalies such as [[Urachus|rachus]], Exstrophy
* [[Congenital]] bladder anomalies such as [[Urachus|rachus]], Exstrophy
| align="center" style="background:#F5F5F5;" + |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical cancer]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cervical cancer]]
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::*'''High parity''' '''DES (diethylstilbestrol)''':  
::*'''High parity''' '''DES (diethylstilbestrol)''':  
| align="center" style="background:#F5F5F5;" + |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bladder stones]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bladder stones]]
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| align="center" style="background:#F5F5F5;" + |CT scan without contrast
| align="center" style="background:#F5F5F5;" + |CT scan without contrast
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
 
Common risk factors in the development of nephrolithiasis include:
* Dietary habits
* Low urinary pH
* [[Hypercalcemia]]
* [[Hypercalciuria]]
* [[Hyperoxaluria]]
* [[Hyperuricemia]]
* [[Hyperuricosuria]]
* [[Metabolic syndrome]]
* [[Obesity]]
* [[Diabetes mellitus]]
* Environmental - such as hot climate
* Drugs
** [[Thiazide]]
** [[Furosemide]]
** [[Sulfadiazine]]
** [[Indinavir]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Urethrolithiasis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Urethrolithiasis
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| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |CT scan without contrast
| align="center" style="background:#F5F5F5;" + |CT scan without contrast
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Same as bladder cancer
| align="center" style="background:#F5F5F5;" + |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurogenic bladder]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurogenic bladder]]
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| align="center" style="background:#F5F5F5;" + |Urodynamic study (UDS)
| align="center" style="background:#F5F5F5;" + |Urodynamic study (UDS)
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
* Spinal cord diseases, injuries
* Neural tube defects including [[spina bifida]].
* [[Brain tumor]]s
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
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* Recent intercourse
* Recent intercourse
* Recent [[catheterization]]
* Recent [[catheterization]]
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] [[discharge]] may suggest [[gonorrhoea]]
*Exclusive [[dysuria]] suggest [[Chlamydia]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis|'''Cystitis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis|'''Cystitis''']]
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*[[BPH]]
*[[BPH]]
*[[HIV]]
*[[HIV]]
| align="left" style="background:#F5F5F5;" + |
* Imaging studies help differentiate the various types
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
|-
|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! colspan="3" |<small>Diagnostic tests</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Hematuria</small>
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* Prior [[STDs]]
* Prior [[STDs]]
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
| align="left" style="background:#F5F5F5;" + |
* Fishy [[odor]] from the [[vagina]] (Whiff test)
* Thin, white/gray homogeneous [[vaginal discharge]]
* [[Microscopy]] (wet prep) and vaginal [[pH]] 
* Clue cells
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis|'''Cervicitis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis|'''Cervicitis''']]
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* Painful sexual intercourse
* Painful sexual intercourse
* Pressure or heaviness in the [[pelvis]]
* Pressure or heaviness in the [[pelvis]]
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] or [[mucopurulent]] endocervical exudate
*Sustained endocervical [[bleeding]] easily induced by a cotton swab
*>10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate endocervical [[inflammation]] caused specifically by ''[[C. trachomatis]]'' or ''[[N. gonorrhea]]''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis|'''Epididymitis''']]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis|'''Epididymitis''']]
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*[[Scrotum|Scrotal]] wall [[erythema]]
*[[Scrotum|Scrotal]] wall [[erythema]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]
| align="left" style="background:#F5F5F5;" + |
*[[Ultrasound]] in patients with [[Testicular pain|acute testicular pain]] to assess for [[testicular torsion]]
*If equivocal do surgical exploration
|-
|-
|}
|}

Revision as of 16:08, 23 January 2019

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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]

  • The following table summarizes the differential diagnosis for Urethral cancer:
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
Bladder cancer + – +/– +/– – – +/– – – – – Malignant cells

RBC

– Biopsy
Cervical cancer – – +/– +/– – – +/– – – – – – – Biopsy
  • Other risk factors for cervical cancer include the following: [16][17]
  • Smoking
  • HIV infection
  • Increased number of sexual partners
  • Young age at time of first sexual intercourse
  • Hormonal contraception
  • High parity DES (diethylstilbestrol):
Bladder stones + – + +/– +/– – – – – – – RBC – CT scan without contrast

Common risk factors in the development of nephrolithiasis include:

Urethrolithiasis + – + + +/– – – – – – – RBC – CT scan without contrast Same as bladder cancer
Neurogenic bladder – – +/– +/– – – – – – – – – – Urodynamic study (UDS)
Urethritis – + – – + +/– – + – Urethral discharge + – Gram stain & mucoid or purulent discharge
Cystitis + + + + + – – + Suprapubic – + >100,000CFU/mL Urine culture
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
  • Number and type of sexual partners (new, casual, or regular)
  • Prior STDs
  • Previous history of symptomatic BV in female partner (in homosexual women)
Cervicitis – + – – + + Cervical Endocervical exudate – – – Culture for gonococcal cervicitis
Epididymitis + – + + + + Testicular & suprapubic +/– urethral discharge + + Culture

References

  1. ↑ 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)
  2. ↑ 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)
  3. ↑ 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)
  4. ↑ 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.
  5. ↑ Taylor-Robinson D (1996). "The history of nongonococcal urethritis. Thomas Parran Award Lecture". Sex Transm Dis. 23 (1): 86–91. PMID 8801649.
  6. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
  7. ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
  8. ↑ 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)
  9. ↑ 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)
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ [1] American Cancer Society
  13. ↑ [2]
  14. ↑ [3]
  15. ↑ [4]
  16. ↑ Kim JJ, Burger EA, Regan C, Sy S. PMID 30212064. Missing or empty |title= (help)
  17. ↑ 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.
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