Despite their prevalence among the aging population, urological disorders are among the most commonly misdiagnosed diseases. Here, five of the most prevalent urology misdiagnoses will be discussed.
Pelvic Organ Prolapse
Pelvic organ prolapse1 is one of the most common urinary disorders among women, as well as one of the most commonly misdiagnosed. This disorder occurs when a pelvic organ prolapses from normal position and pushes against the vaginal wall.
Five different organs can be affected, including the bladder, small bowel, rectum, uterus, and vaginal vault. The most typical symptoms of pelvic organ prolapse include pelvic pain, discomfort during intercourse, constipation, backache, and incontinence, among others. According to the Association for Pelvic Organ Prolapse, over 50% of women over 50 have some form of this disorder.
The most common disorders that pelvic organ prolapse is mistakenly diagnosed as include urinary and fecal incontinence, constipation, and irritable bowel disease. Unfortunately, when pelvic organ prolapse is misdiagnosed as urinary incontinence, surgical outcomes are poor and women can be left with worsened conditions.
Pelvic organ prolapse can be diagnosed during a routine pelvic exam. Additional tests include urinary tract X-ray, a CT scan of the pelvis, pelvic ultrasound, and MRI scans of the pelvis.
Urinary Incontinence Disorders
Urinary incontinence, which occurs when patients are unable to control their bladders, is commonly misdiagnosed – particularly among certain demographics of people. For example, among incontinent institutionalized women2, patients with detrusor hyperactivity with impaired contractility were frequently incorrectly diagnosed with stress incontinence. Additionally, urinary incontinence can be a symptom of a larger disorder, and incorrect diagnosis will obscure diagnosis and treatment.
There are a number of alternative diagnoses for urinary incontinence, and before scheduling invasive treatment for a patient with this disorder the underlying cause should be elucidated. Disorders that have similar symptoms as urinary incontinence include cystitis, prostatitis, use of certain medications, polyuria, vesicovaginal fistula, uretovaginal fistula, dementia, and normal pressure hydrocephalus, among others.
To determine the underlying cause of urinary incontinence, a full urodynamic workup should be performed following the guidelines set forth by the American Urological Association.
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Interstitial Cystitis
Whereas pelvic organ prolapse is frequently misdiagnosed in women, interstitial cystitis is among the most commonly misdiagnosed disorders for men3. Also known as painful bladder syndrome, interstitial cystitis symptoms include pain in the bladder, pelvis, penis, or testicles as well as a frequent urge to urinate. A hallmark symptom of interstitial cystitis is discomfort during bladder filling and chronic pain that only goes away when the bladder is emptied.
Most commonly, interstitial cystitis is misdiagnosed as chronic bladder infection or urinary tract infection. Other misdiagnoses include prostatitis, epididymitis, and benign prostatic hyperplasia.
To achieve the proper diagnosis, a physical exam along with the patient’s detailed medical history should be considered. Infection, symptoms caused by medications, and radiation should be excluded. Cystoscopy, biopsy, urine cytology, and a potassium sensitivity test may also be performed.
Prostatitis / Chronic Pelvic Pain Syndrome
Chronic Pelvic Pain Syndrome4, which is sometimes confused as Prostatitis, is frequently misdiagnosed due to the common occurrence of men developing prostate symptoms as they age. Frequently, symptoms that occur as a result of prostatitis are pelvic, urinary, rectal, or genital pain; as well as urinary symptoms such as urinary frequency, urinary urgency, dysuria, pain while sitting, and ejaculatory discomfort.
Unfortunately, patients showing symptoms of prostatitis are often prescribed antibiotics for a prostate infection, without the presence of an infection being verified. The treatment of a non-existing infection with antibiotics is inappropriate and does not address the underlying cause, such as pelvic muscle dysfunction.
To confirm prostatitis, infection should first be confirmed before treatment is administered. A full physical exam following these guidelines, should also be performed.
Bladder Cancer
Despite the prevalence of bladder cancer, it is among one of the most misdiagnosed diseases. Bladder cancer symptoms include pain while urinating, dark urine, frequent urination, and bloody urine. Pelvic pain can also occur.
The symptoms of bladder cancer are strikingly similar to urinary tract infection. Indeed, the most common misdiagnosis of bladder cancer is UTI, which delays treatment of the cancer.
Patients with blood in their urine should undergo cystoscopy to look for the presence of abnormalities or tumors in the bladder.
References
- Awwad J, Sayegh R, Yeretzian J, Deeb ME. Prevalence, risk factors, and predictors of pelvic organ prolapse: a community-based study. Menopause. 2012;19(11):1235-41. Link
- Resnick NM, Brandeis GH, Baumann MM, Dubeau CE, Yalla SV. Misdiagnosis of urinary incontinence in nursing home women: prevalence and a proposed solution. Neurourol Urodyn. 1996;15(6):599-613. Link
- Arora HC, Shoskes DA. The enigma of men with interstitial cystitis/bladder pain syndrome. Translational Andrology and Urology. 2015;4(6):668-676. doi:10.3978/j.issn.2223-4683.2015.10.01. Link
- Smith CP. Male chronic pelvic pain: An update. Indian Journal of Urology : IJU : Journal of the Urological Society of India. 2016;32(1):34-39. doi:10.4103/0970-1591.173105. Link