Differential Diagnosis for 54-year-old Male with Penile Tenderness and Urinary Symptoms

• Single most likely diagnosis:
  • Prostatitis: Given the patient's history of an enlarged prostate, the symptoms of tenderness at the head of the penis, urinary urgency, and frequency are consistent with prostatitis, which is an inflammation of the prostate gland. The absence of discharge and new sexual partners reduces the likelihood of a sexually transmitted infection (STI), making prostatitis a more probable cause.
• Other Likely diagnoses:
  • Urinary Tract Infection (UTI): Although the patient denies discharge, a UTI could still be present, especially in a diabetic patient who is more prone to infections. The symptoms of urinary urgency and frequency support this diagnosis.
  • Benign Prostatic Hyperplasia (BPH) exacerbation: The patient's known history of an enlarged prostate could be contributing to his current symptoms, especially if the BPH is causing obstruction or irritation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Testicular or Penile Cancer: Although rare, testicular or penile cancer could present with penile tenderness and should not be overlooked, especially in the absence of other obvious causes.
  • Kidney Stones: Severe pain and urinary symptoms could indicate kidney stones, which require prompt medical attention to prevent complications.
  • Sepsis (from an untreated UTI or prostatitis): If the patient's condition is not properly managed, it could lead to sepsis, a life-threatening condition.
• Rare diagnoses:
  • Peyronie's Disease: This condition involves the development of scar tissue inside the penis, leading to curved, painful erections. It's less likely given the patient's symptoms but could be considered if other diagnoses are ruled out.
  • Urethral Stricture: Narrowing of the urethra could cause urinary symptoms but would typically present with more obstructive symptoms and possibly a history of trauma or infection.