Differential Diagnosis

The patient presents with a complex set of symptoms including dysuria, reduced urinary output, painful left buttocks, hip, thigh, and inguinal area, along with urinary retention and constipation. Considering these symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Prostatitis: Given the patient's symptoms of dysuria, urinary retention, and pain radiating from the groin and scrotum to the left hip, thigh, and buttock, prostatitis is a strong consideration. The patient's occupation involving prolonged sitting and frequent lifting could exacerbate prostate issues.

• Other Likely Diagnoses

  • Urinary Tract Infection (UTI): The symptoms of dysuria and reduced urinary output could suggest a UTI, which might have ascended to involve the prostate, leading to prostatitis.
  • Kidney Stone: Pain radiating from the groin to the back could indicate a kidney stone, especially if it is obstructing the ureter. However, the absence of nausea and vomiting makes this less likely.
  • Piriformis Syndrome: Given the pain in the buttock and thigh, piriformis syndrome could be considered, especially with the patient's history of prolonged sitting and lifting, which could irritate the piriformis muscle.

• Do Not Miss Diagnoses

  • Testicular Torsion: Although the patient's pain has been present for three weeks, which is longer than typical for testicular torsion, any condition involving acute testicular pain should prompt consideration of this emergency.
  • Spinal Epidural Abscess: Back pain and neurological symptoms such as urinary retention could indicate a spinal epidural abscess, a serious condition requiring immediate intervention.
  • Cauda Equina Syndrome: This condition, characterized by low back pain, urinary retention, and radicular pain in the lower limbs, is a surgical emergency.

• Rare Diagnoses

  • Prostate Cancer: While less likely given the acute presentation, prostate cancer could cause urinary retention and pain, especially if metastatic.
  • Pudendal Neuralgia: This condition involves chronic pain in the distribution of the pudendal nerve and could explain some of the patient's symptoms, though it is less common.
  • Lymphoma or Other Malignancies: In rare cases, malignancies could cause the constellation of symptoms described, particularly if there is metastasis to the spine or pelvic area.