Differential Diagnosis for a 62-year-old Male with Inability to Urinate
Single Most Likely Diagnosis
- Benign Prostatic Hyperplasia (BPH): This condition is common in older men and can cause urinary retention due to the enlargement of the prostate gland, which compresses the urethra.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): A UTI can cause discomfort and difficulty urinating, potentially leading to urinary retention.
- Prostate Cancer: Similar to BPH, prostate cancer can cause urinary retention by compressing or invading the urethra.
- Neurogenic Bladder: Conditions affecting the nerves that control bladder function, such as diabetes or spinal cord injuries, can lead to urinary retention.
- Medication Side Effects: Certain medications, like anticholinergics or decongestants, can cause urinary retention as a side effect.
Do Not Miss Diagnoses
- Acute Kidney Injury: Although less likely, acute kidney injury can present with an inability to urinate and is critical to diagnose early to prevent long-term damage.
- Spinal Cord Compression: This is a medical emergency that can cause neurogenic bladder and requires immediate intervention to prevent permanent damage.
- Post-Renal Acute Kidney Injury (e.g., due to kidney stones): Obstruction in the urinary tract can cause acute kidney injury and must be promptly addressed.
Rare Diagnoses
- Urethral Stricture: A narrowing of the urethra, often due to injury or infection, which can cause difficulty urinating.
- Bladder Neck Contracture: Scarring at the bladder neck can obstruct urine flow, leading to retention.
- Phimosis: A condition where the foreskin cannot be fully retracted over the glans penis, potentially causing urinary obstruction in uncircumcised males.
Each of these diagnoses has a different set of implications for treatment and patient outcomes, emphasizing the importance of a thorough diagnostic approach.