Differential Diagnosis for Hematuria and Abdominal Pain

The patient's symptoms of blood in urine, pain, and pressure in the abdomen during urination, combined with a long smoking history, suggest several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Bladder Cancer: The patient's long smoking history is a significant risk factor for bladder cancer, which often presents with painless hematuria. However, the presence of pain and pressure could indicate an advanced stage or a complication such as a tumor causing obstruction.

• Other Likely Diagnoses

  • Urinary Tract Infection (UTI): Although UTIs are more common in women, men can also develop UTIs, especially with a history of smoking, which might impair immune function. Symptoms can include dysuria, hematuria, and abdominal pressure.
  • Kidney Stones: Smoking is a risk factor for kidney stones, which can cause severe pain (renal colic), hematuria, and discomfort during urination if a stone is obstructing the urinary tract.
  • Prostatitis: In men, prostatitis can cause pain during urination, hematuria, and abdominal or pelvic pain. A long smoking history might contribute to chronic inflammation.

• Do Not Miss Diagnoses

  • Sepsis from a UTI: If the UTI has progressed to sepsis, it could be life-threatening. Symptoms might include fever, chills, and severe abdominal pain, in addition to the urinary symptoms.
  • Renal Infarction: Although less common, renal infarction (a blockage of the blood supply to the kidney) can cause severe pain and hematuria. It's crucial to diagnose promptly to preserve kidney function.

• Rare Diagnoses

  • Sickle Cell Disease or Sickle Cell Trait: In individuals with sickle cell disease or trait, sickling crises can cause renal infarction and subsequent hematuria. This would be more relevant if the patient has a known history of sickle cell disease or if there's a family history.
  • Goodpasture Syndrome: A rare autoimmune disease that can cause glomerulonephritis and pulmonary hemorrhage. It might present with hematuria and could be considered in a smoker with renal and pulmonary symptoms, although it's much less likely than other diagnoses.