Differential Diagnosis for a 70-year-old Male with Slow Stream and Prostate Size 20 gm

• Single most likely diagnosis:
  • Benign Prostatic Hyperplasia (BPH) with obstruction: This is the most likely diagnosis given the patient's age, symptoms of slow stream, and an enlarged prostate size of 20 gm. BPH is a common condition in older men where the prostate gland enlarges, potentially causing urinary symptoms due to obstruction of the urethra.
• Other Likely diagnoses:
  • Prostatitis: Although less common in this age group without other symptoms like pain or fever, prostatitis (inflammation of the prostate) could cause similar urinary symptoms and should be considered.
  • Detrusor muscle weakness: This condition, where the muscle in the bladder wall that helps to empty the bladder becomes weak, could also lead to symptoms of slow stream and urinary retention, especially in older adults.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Prostate Cancer: Although the size of the prostate alone is not diagnostic, prostate cancer must be considered, especially in older men. A digital rectal exam (DRE) and possibly a prostate-specific antigen (PSA) test should be performed to evaluate for this possibility.
  • Neurogenic bladder: Conditions affecting the nerves controlling the bladder, such as diabetes, stroke, or spinal cord injuries, can cause urinary retention and slow stream. These conditions require prompt diagnosis and treatment to prevent complications.
• Rare diagnoses:
  • Urethral stricture: A narrowing of the urethra, which could be due to injury, infection, or inflammation, might cause obstructive urinary symptoms similar to BPH.
  • Bladder neck contracture: Scarring at the bladder neck can cause obstructive urinary symptoms and is a consideration, especially if there's a history of surgical interventions in the area.