Differential Diagnosis for Bladder Distension and Prostate Enlargement

Single Most Likely Diagnosis

• Benign Prostatic Hyperplasia (BPH): The presence of a distended bladder with smooth and regular walls, along with an enlarged prostate and a solid nodule, strongly suggests BPH. The symptoms and findings are consistent with urinary retention due to prostate enlargement, which is a common condition in older males.

Other Likely Diagnoses

• Urinary Retention: This could be due to various causes including neurogenic bladder, bladder outlet obstruction (which could be caused by the enlarged prostate), or other factors leading to an inability to fully empty the bladder.
• Prostatitis: Inflammation of the prostate could cause enlargement and potentially lead to urinary retention or bladder distension, though the absence of specific symptoms like pain or fever makes this less likely.
• Prostate Cancer: The presence of a solid nodule within the enlarged prostate raises the concern for malignancy, which could also lead to urinary obstruction and bladder distension.

Do Not Miss Diagnoses

• Neurogenic Bladder: This condition, resulting from a neurological condition affecting bladder control, could lead to urinary retention and bladder distension. It's crucial to consider this diagnosis due to its significant impact on management and potential for serious complications if missed.
• Bladder Outlet Obstruction due to Other Causes: Other than BPH, obstruction could be caused by bladder stones, tumors, or strictures, which would require different management approaches.

Rare Diagnoses

• Sarcoma of the Prostate: A rare malignant tumor of the prostate that could cause rapid enlargement and obstructive symptoms.
• Cystosarcoma Phyllodes of the Prostate: An extremely rare tumor that could present with similar findings.
• Bladder Diverticulum with Obstruction: Although diverticula were not seen on the submitted views, a rare possibility could be a diverticulum causing obstruction, though this seems less likely given the information provided.

Each of these diagnoses requires careful consideration of the patient's symptoms, physical examination, and additional diagnostic tests such as urine analysis, prostate-specific antigen (PSA) levels, and potentially imaging studies or cystoscopy to determine the exact cause of the bladder distension and prostate enlargement.