Differential Diagnosis for a 65yo Male with Painful Urination

Single Most Likely Diagnosis

• BPH (Benign Prostatic Hyperplasia): This is the most likely diagnosis given the patient's age and symptoms. BPH is a common condition in older men that can cause painful urination, frequency, and urgency due to an enlarged prostate gland obstructing the flow of urine.

Other Likely Diagnoses

• Prostatitis: This is an inflammation of the prostate gland, which can be caused by infection or other factors. It can cause painful urination, fever, and pelvic pain, making it a likely consideration in this patient.
• UTI (Urinary Tract Infection): While less common in men than women, UTIs can occur in older men, especially if they have an underlying condition like BPH. Symptoms include painful urination, frequency, and urgency.

Do Not Miss Diagnoses

• Prostate Cancer: Although less likely, prostate cancer can cause similar symptoms to BPH and prostatitis, including painful urination. Given the potential severity of this diagnosis, it is crucial not to miss it.
• Septicemia or Urosepsis: Infection spreading from the urinary tract to the bloodstream can be life-threatening. Symptoms might include fever, chills, and severe pain, making prompt diagnosis and treatment critical.

Rare Diagnoses

• Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can overlap with those of UTIs or prostatitis but are less common in men.
• Bladder or Urethral Stones: While more common in women, stones can cause severe pain and obstruct urine flow in men, especially if they have an underlying condition like BPH.
• Tuberculosis of the Urinary Tract: A rare infection that can cause symptoms similar to those of UTIs or prostatitis, including painful urination, but is less common in areas with good healthcare access.