Differential Diagnosis for Split Stream Urine, Urinary Hesitancy, and Normal Prostate Size
Single Most Likely Diagnosis
- Urethral Stricture: This condition is characterized by a narrowing of the urethra, which can cause split stream urine and urinary hesitancy. The normal prostate size reduces the likelihood of prostate-related obstruction, making urethral stricture a more probable cause.
Other Likely Diagnoses
- Neurogenic Bladder: This condition, resulting from nerve damage affecting bladder control, can lead to urinary hesitancy and changes in urine stream. Although less common, it remains a plausible diagnosis given the symptoms.
- Urethral Diverticulum: A condition where a pouch or pocket forms in the urethra, potentially causing urinary symptoms including split stream and hesitancy, especially if the diverticulum is large enough to obstruct urine flow.
Do Not Miss Diagnoses
- Urethral Cancer: Although rare, urethral cancer can present with obstructive urinary symptoms such as split stream and hesitancy. Given its potential severity and impact on prognosis with early detection, it is crucial not to miss this diagnosis.
- Bladder Neck Contracture: A condition that can occur after surgical procedures or due to inflammation, leading to narrowing of the bladder neck and causing obstructive urinary symptoms.
Rare Diagnoses
- Sphincter Dyssynergia: A condition where the external urethral sphincter fails to relax during voiding, potentially causing obstructive symptoms. It is more commonly associated with neurologic conditions.
- Prostatic Urethral Narrowing due to Inflammation or Fibrosis: Even with a normal-sized prostate, inflammation or fibrosis within the prostate can cause urethral narrowing, leading to obstructive symptoms. This would be less common than other causes but remains a consideration.