Differential Diagnosis for Pyuria and Hematuria in Men
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): This is the most common cause of pyuria (presence of pus in the urine) and hematuria (blood in the urine) in men. Bacterial infections, such as those caused by E. coli, are a frequent cause of UTIs, which can lead to inflammation and subsequent pyuria and hematuria.
Other Likely Diagnoses
- Kidney Stones: Kidney stones can cause both pyuria and hematuria due to the irritation and trauma they inflict on the urinary tract lining. The stones can also obstruct the flow of urine, leading to infection.
- Prostatitis: Inflammation of the prostate gland can cause pyuria and hematuria, especially if the inflammation is severe or if there is a bacterial infection involved.
- Benign Prostatic Hyperplasia (BPH): Although more commonly associated with lower urinary tract symptoms, BPH can occasionally cause hematuria, especially if there is associated urinary retention or infection.
Do Not Miss Diagnoses
- Bladder Cancer: Although less common, bladder cancer is a critical diagnosis not to miss, as it can present with painless hematuria. The presence of pyuria could indicate a concurrent infection, which might complicate the diagnosis.
- Kidney Cancer: Similar to bladder cancer, kidney cancer can cause hematuria and, less commonly, pyuria if there is tumor invasion into the collecting system or associated infection.
- Tuberculosis (TB) of the Urinary Tract: Genitourinary TB can cause chronic pyuria and hematuria, along with other symptoms like frequency, urgency, and flank pain. It's crucial not to miss this diagnosis due to its treatable nature and potential for severe consequences if left untreated.
Rare Diagnoses
- Schistosomiasis: This parasitic infection, common in certain parts of the world, can cause chronic hematuria and pyuria due to the eggs of the parasite causing inflammation in the bladder wall.
- Goodpasture Syndrome: A rare autoimmune disease that can cause glomerulonephritis, leading to hematuria, and potentially pyuria if there is an associated infection.
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes, which can lead to hematuria. Pyuria might be present if there's a secondary infection.