Differential Diagnosis for 68-year-old Male with Urination Difficulty
Single Most Likely Diagnosis
- Benign Prostatic Hyperplasia (BPH): The patient's age and symptoms of difficulty urinating, increased frequency, urgency, bladder pressure, and retention are classic for BPH. The negative urinalysis also supports this diagnosis, as BPH is not typically associated with urinary tract infections.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): Although the urinalysis is negative, UTIs can sometimes present with negative initial tests, especially in men. The symptoms of frequency, urgency, and bladder pressure could still be consistent with a UTI.
- Prostatitis: Inflammation of the prostate gland could cause the patient's symptoms, including difficulty urinating and pelvic pain. The negative urinalysis does not rule out prostatitis entirely.
- Bladder Outlet Obstruction: This could be due to various causes, including bladder stones, tumors, or strictures, and would explain the patient's difficulty urinating and retention.
Do Not Miss Diagnoses
- Prostate Cancer: Although less likely, prostate cancer could present with similar symptoms to BPH, and it is crucial to rule out this potentially life-threatening condition, especially given the patient's age.
- Neurogenic Bladder: A condition where the bladder does not function properly due to a neurological condition, such as a stroke, spinal cord injury, or multiple sclerosis. This could explain the patient's urinary retention and difficulty urinating.
- Spinal Cord Compression: Compression of the spinal cord could cause urinary retention and difficulty urinating, among other symptoms. This is a medical emergency that requires prompt attention.
Rare Diagnoses
- Bladder Cancer: Although less common than prostate cancer, bladder cancer could present with similar symptoms, including difficulty urinating and bladder pressure.
- Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms could fit, but this diagnosis is less likely given the acute onset.
- Urethral Stricture: A narrowing of the urethra that could cause difficulty urinating and retention. This is a less common condition but should be considered in the differential diagnosis.