Differential Diagnosis for 55-year-old Male with Lower Back Pain and Urinary Symptoms
- Single most likely diagnosis:
- Nephrolithiasis (kidney stones): The patient's history of kidney stones, recent physical activity (pulling weeds), and symptoms of lower back pain, urinary urgency, frequency, and relief with soaking in a warm tub are consistent with a kidney stone. The pain radiating to the right groin/testicle also suggests a stone moving down the ureter.
- Other Likely diagnoses:
- Urinary Tract Infection (UTI): Although the patient is not concerned about STDs and is not sexually active, a UTI could still occur, especially with the symptoms of urinary urgency and frequency.
- Musculoskeletal strain: The patient's recent physical activity (pulling weeds and working a 24-hour shift) could have led to a musculoskeletal strain, causing lower back pain.
- Prostatitis: Although the patient is not sexually active, prostatitis could still occur, and the symptoms of urinary urgency, frequency, and lower back pain could be consistent with this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Testicular torsion: Although the patient's symptoms have improved, testicular torsion is a medical emergency that requires prompt attention. The pain in the right groin/testicle could be a sign of this condition.
- Appendicitis: The patient's symptoms of lower back pain, urinary urgency, and frequency could be consistent with appendicitis, especially if the appendix is located near the ureter.
- Sepsis: If the patient has a UTI or kidney stone, there is a risk of sepsis, especially in older adults or those with underlying medical conditions.
- Rare diagnoses:
- Epididymitis: Although the patient is not sexually active, epididymitis could still occur, and the symptoms of lower back pain, urinary urgency, and frequency could be consistent with this diagnosis.
- Retroperitoneal hemorrhage: This is a rare but potentially life-threatening condition that could occur in patients with underlying medical conditions, such as bleeding disorders or anticoagulant use.