Differential Diagnosis for Grossly Edematous Penis with Extreme Urine Retention and Foley Obstruction

• Single Most Likely Diagnosis
  • Phimosis: This condition, where the foreskin cannot be fully retracted over the glans penis, can lead to urine retention and edema due to the obstruction of the urinary meatus. The presentation of gross penile edema and difficulty with urination strongly suggests an obstructive process, with phimosis being a common cause.
• Other Likely Diagnoses
  • Paraphimosis: A condition where the foreskin is retracted behind the glans and cannot return to its original position, potentially cutting off blood flow and leading to edema. This can also cause urinary retention due to the swelling and pain.
  • Urethral Stricture: Narrowing of the urethra can cause obstructive urinary symptoms, including severe urine retention. The edema could be secondary to the obstruction or due to an attempt to catheterize through the stricture, causing further trauma.
  • Penile Cancer: Though less common, penile cancer can present with a mass or ulceration that could obstruct the urethra, especially if the tumor is located near the meatus, leading to urine retention and secondary edema.
• Do Not Miss Diagnoses
  • Fournier's Gangrene: A life-threatening condition characterized by necrotizing fasciitis of the genitalia. Early signs can include edema, pain, and urinary retention due to the inflammatory process. Missing this diagnosis could be fatal.
  • Acute Urinary Retention due to Neurogenic Bladder: Conditions affecting the spinal cord or peripheral nerves can lead to urinary retention. The edema might be secondary to another process, but the urinary retention could be the presenting symptom of a neurogenic bladder.
• Rare Diagnoses
  • Lymphogranuloma Venereum (LGV): A sexually transmitted infection that can cause lymphadenopathy and, in rare cases, genital edema. While not typically associated with urinary retention, it could potentially cause urethral stricture or other complications leading to obstruction.
  • Fabry Disease: A genetic disorder that can lead to the accumulation of a particular type of fat in the body's cells, affecting many parts of the body. It can cause peripheral nerve damage, potentially leading to neurogenic bladder and, consequently, urinary retention. The edema could be related to other systemic manifestations of the disease.