Differential Diagnosis for a 26-Year-Old Male with Urinary Frequency, Nocturia, Pain on Ejaculation, and Suprapubic Fullness

• Single Most Likely Diagnosis

  • Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): This condition is characterized by chronic pain in the pelvic region, often accompanied by urinary frequency, nocturia, and pain during ejaculation. The symptoms described align closely with CP/CPPS, making it a strong candidate for the single most likely diagnosis.

• Other Likely Diagnoses

  • Urinary Tract Infection (UTI): Although less common in men, UTIs can cause frequency, nocturia, and suprapubic discomfort. The presence of pain on ejaculation might be less typical but could be seen in cases of prostatitis secondary to UTI.
  • Benign Prostatic Hyperplasia (BPH): While BPH is more common in older men, it can occur in younger individuals. Symptoms include urinary frequency, nocturia, and a feeling of incomplete bladder emptying, which might contribute to the sensation of suprapubic fullness.
  • Overactive Bladder: This condition is characterized by urinary urgency, frequency, and nocturia, with or without urge incontinence. While it doesn't directly explain pain on ejaculation, it could contribute to the urinary symptoms.

• Do Not Miss Diagnoses

  • Testicular Cancer: Although testicular cancer is not directly related to the symptoms described, it's crucial to consider due to the potential for metastasis to the retroperitoneum, which could indirectly cause some of these symptoms. Early detection is key.
  • Prostate Cancer: Similar to testicular cancer, prostate cancer might not directly cause all these symptoms, especially in a young man. However, given the potential severity, it's essential to rule out, especially if there's a family history or other risk factors.
  • Neurogenic Bladder: Conditions affecting the spinal cord or nerves controlling the bladder can lead to urinary retention, frequency, and nocturia. This diagnosis is critical to consider due to its implications for bladder and kidney health.

• Rare Diagnoses

  • Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can overlap with those described, but it's less common in men.
  • Spondyloarthritis (e.g., Ankylosing Spondylitis): Some forms of spondyloarthritis can involve the genitourinary system, leading to symptoms like those described, although this would be uncommon and typically accompanied by other systemic symptoms.
  • Bladder or Urethral Stones: While stones can cause severe pain and urinary symptoms, the specific combination described, including pain on ejaculation and suprapubic fullness, would be less typical.