Differential Diagnosis for a 50-year-old with Dysuria and Intermittency

Single most likely diagnosis

• Benign Prostatic Hyperplasia (BPH): This condition is common in men over 50 and can cause dysuria and intermittency due to obstruction of the urethra by an enlarged prostate.

Other Likely diagnoses

• Urinary Tract Infection (UTI): Although the patient has no fever, UTIs can sometimes present without systemic symptoms, especially in older adults. The symptoms of dysuria and intermittency could be indicative of a lower urinary tract infection.
• Overactive Bladder: This condition can cause urinary urgency, frequency, and nocturia, but some patients may also experience dysuria and intermittency due to bladder muscle overactivity.
• Prostatitis: Inflammation of the prostate gland can cause dysuria, pain, and urinary frequency or intermittency, and can occur without fever.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

• Prostate Cancer: Although less likely, prostate cancer can cause obstructive urinary symptoms similar to BPH, including dysuria and intermittency. Early detection is crucial for effective treatment.
• Bladder Cancer: This is another critical diagnosis not to miss, as it can also present with urinary symptoms such as dysuria and changes in urination patterns.
• Neurogenic Bladder: Conditions affecting the nerves controlling the bladder can lead to a range of urinary symptoms, including dysuria and intermittency, and require prompt diagnosis to prevent complications.

Rare diagnoses

• Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which can lead to dysuria and changes in urinary habits.
• Urethral Stricture: Narrowing of the urethra can cause obstructive urinary symptoms, including dysuria and intermittency, and is more common in men.
• Bladder Outlet Obstruction due to other causes: Such as bladder stones, urethral valves, or other less common obstructive pathologies.