Differential Diagnosis for Gross Hematuria after Sex in a 62-Year-Old Male
Single Most Likely Diagnosis
- Benign Prostatic Hyperplasia (BPH): This condition is common in older men and can cause urinary symptoms, including hematuria, especially after sexual activity due to increased prostate congestion and potential minor trauma to the prostate or bladder.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): While more common in women, men can also develop UTIs, which can cause hematuria. Sexual activity can introduce bacteria into the urinary system, leading to infection.
- Kidney Stones: Stones can cause intermittent hematuria, and the pain or discomfort associated with stones might be exacerbated by the physical activity of sex.
- Bladder Cancer: Although less common than BPH, bladder cancer is a consideration in older adults presenting with hematuria. Risk factors include smoking and exposure to certain chemicals.
Do Not Miss Diagnoses
- Prostate Cancer: While less likely than BPH to cause hematuria, prostate cancer is a critical diagnosis not to miss, especially in older men. Hematuria could be a symptom of advanced disease.
- Trauma to the Genitourinary Tract: Direct injury to the penis, urethra, bladder, or kidneys during sexual activity could cause hematuria and needs to be considered to ensure appropriate treatment.
- Bleeding Disorders: Conditions like hemophilia or the use of anticoagulant medications could predispose to bleeding, including hematuria, after minor trauma such as sexual activity.
Rare Diagnoses
- Arteriovenous Malformation (AVM) or Vascular Anomalies: Rare vascular abnormalities in the urinary tract could cause hematuria, especially if they are affected by the increased blood flow or pressure changes during sexual activity.
- Sickle Cell Disease: In patients with sickle cell disease, hematuria can occur due to sickling in the low-oxygen environment of the kidney medulla. This would be more relevant if the patient has a known history of the disease.
- Schistosomiasis: A parasitic infection that can cause bladder pathology, including hematuria. This diagnosis would be considered in individuals who have traveled to or lived in areas where the disease is endemic.