What is the diagnosis for a 74-year-old female presenting with dysuria, urinary urgency, and frequency, with a urinalysis (UA) showing small leukocyte esterase and trace hematuria, despite a previous urine culture showing no bacterial growth, and who is being treated for overactive bladder (OAB)?

Differential Diagnosis for 74-year-old Female with Urinary Symptoms

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI) with Colonization or Contamination: Despite the previous culture showing no bacterial growth, the presence of leukocyte esterase and trace blood in the urine, along with symptoms of dysuria, urgency, and frequency, suggests a possible UTI. The lack of bacterial growth could be due to colonization, contamination, or the use of antibiotics before the culture was taken.

Other Likely Diagnoses

• Overactive Bladder (OAB) Exacerbation: The patient is already being treated for OAB, and the symptoms of urgency and frequency could be an exacerbation of this condition.
• Interstitial Cystitis: A chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain, which could explain the patient's symptoms of dysuria and frequency.
• Urethral Syndrome: A condition that presents with symptoms similar to UTI, such as dysuria and frequency, but without evidence of infection.

Do Not Miss Diagnoses

• Bladder Cancer: Although less likely, bladder cancer could present with hematuria (trace blood in the urine) and urinary symptoms, making it a critical diagnosis not to miss.
• Kidney Stones: Could cause severe pain, dysuria, and hematuria, and although the patient's symptoms are intermittent, it's essential to consider this diagnosis.
• Pyelonephritis: An infection of the upper urinary tract, which could present with similar symptoms to UTI, but with more severe consequences if left untreated.

Rare Diagnoses

• Tuberculosis of the Urinary Tract: A rare condition that could present with chronic urinary symptoms, hematuria, and sterile pyuria (leukocytes in the urine without bacterial growth).
• Sarcoidosis Involving the Urinary Tract: A rare condition where sarcoidosis affects the urinary tract, causing symptoms similar to UTI or interstitial cystitis.
• Fungal Infections of the Urinary Tract: Rare, especially in non-immunocompromised patients, but could present with similar symptoms to bacterial UTI.