Differential Diagnosis
- Single most likely diagnosis
- E) Prostatitis: The patient's symptoms of low back pain, urinary hesitancy, and pain with urination, along with a history of similar episodes, are consistent with prostatitis. The rectal examination finding of a diffuse, minimally enlarged, tender prostate with no masses further supports this diagnosis. The elevated serum prostate-specific antigen (PSA) level can also be seen in prostatitis.
- Other Likely diagnoses
- G) Urolithiasis: The patient's symptoms of low back pain and pain with urination could be indicative of a kidney stone. However, the absence of costovertebral angle tenderness and the lack of hematuria make this diagnosis less likely.
- B) Cystitis: Although the patient has pain with urination, the absence of other symptoms such as frequent urination, urgency, and hematuria, as well as the negative urine dipstick results, make cystitis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- F) Pyelonephritis: While the patient does not have the typical symptoms of pyelonephritis, such as fever, flank pain, and costovertebral angle tenderness, this diagnosis should not be missed due to its potential severity. The absence of these symptoms and the negative urine dipstick results make pyelonephritis less likely.
- D) Prostate cancer: Although the patient's PSA level is elevated, his age and the absence of other symptoms such as weight loss or bone pain make prostate cancer less likely. However, an elevated PSA level should always be investigated further.
- Rare diagnoses
- A) Benign prostatic hypertrophy: This diagnosis is less likely in a 32-year-old man, as benign prostatic hypertrophy typically occurs in older men.
- C) Epididymitis: The patient's symptoms and physical examination findings do not suggest epididymitis, which typically presents with testicular pain and swelling.