Differential Diagnosis for a 44-year-old Male with Urinary Symptoms and Abdominal Tenderness

• Single most likely diagnosis:
  • Urinary Retention due to Benign Prostatic Hyperplasia (BPH): The symptoms of incomplete emptying of the bladder, abdominal tenderness, and deep palpation tenderness in the left iliac fossa and suprapubic area are consistent with urinary retention, which is commonly caused by BPH in men of this age group.
• Other Likely diagnoses:
  • Urinary Tract Infection (UTI): Symptoms such as frequent urination in small amounts and abdominal tenderness could also suggest a UTI, especially if there are associated symptoms like dysuria or fever.
  • Prostatitis: Inflammation of the prostate gland could cause similar symptoms, including urinary frequency, incomplete bladder emptying, and abdominal pain.
  • Overactive Bladder: This condition could lead to urinary frequency and urgency, though it might not fully explain the abdominal tenderness.
• Do Not Miss diagnoses:
  • Kidney Stones: Although the primary symptoms are not typical for kidney stones (e.g., severe, colicky pain), it's crucial not to miss this diagnosis due to the potential for severe pain and complications like obstruction or infection.
  • Bladder Cancer: While less common, bladder cancer can present with urinary symptoms and abdominal pain, making it a critical diagnosis not to overlook, especially in older adults or those with risk factors like smoking.
  • Sepsis from a Urinary Source: Any infection in the urinary tract has the potential to lead to sepsis, a life-threatening condition that requires immediate medical attention.
• Rare diagnoses:
  • Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which could fit some of the symptoms but is less common.
  • Neurogenic Bladder: A condition where a person has trouble with bladder control due to a brain, spinal cord, or nerve problem, which might lead to symptoms of incomplete emptying but would typically have other neurological signs.
  • Bladder Outlet Obstruction due to Other Causes (e.g., bladder neck contracture, urethral stricture): These are less common causes of urinary retention and would typically have specific histories or findings on examination.