Differential Diagnosis for Hematuria and Burning Micturition
Single Most Likely Diagnosis
- Urethral Stricture: This condition is characterized by a narrowing of the urethra, which can cause obstructive and irritative lower urinary tract symptoms, including hematuria and dysuria (burning micturition). The absence of UTI or renal malignancy makes this a plausible cause.
Other Likely Diagnoses
- Kidney Stones: Although not directly related to burning micturition, kidney stones can cause hematuria. The pain associated with stones can sometimes be referred to the urethra, causing a burning sensation during urination.
- Prostatitis: Inflammation of the prostate gland can cause irritative symptoms such as burning micturition and hematuria, especially in men.
- Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can include hematuria and a feeling of burning while urinating.
Do Not Miss Diagnoses
- Bladder Cancer: Although less likely given the absence of other risk factors or symptoms, bladder cancer can present with hematuria and irritative voiding symptoms. Missing this diagnosis could be catastrophic.
- Tuberculosis of the Urinary Tract: A rare but serious condition that can cause hematuria, dysuria, and other systemic symptoms. It's crucial not to miss this diagnosis due to its potential for severe consequences if left untreated.
- Sickle Cell Disease or Trait: In patients with sickle cell disease or trait, hematuria can occur due to sickling in the hypoxic environment of the kidney medulla. This is a critical diagnosis not to miss due to its implications for management and potential complications.
Rare Diagnoses
- Schistosomiasis: A parasitic infection that can cause hematuria, particularly in endemic areas. It's a rare cause of these symptoms in non-endemic areas but should be considered in travelers or immigrants from affected regions.
- Urethral Caruncle or Diverticulum: Benign conditions of the urethra that can cause local irritation, leading to symptoms such as burning micturition and possibly hematuria.
- Eosinophilic Cystitis: A rare inflammatory condition of the bladder that can cause a range of symptoms including hematuria and dysuria.