Differential Diagnosis for LUTS

The patient presents with Lower Urinary Tract Symptoms (LUTS) and imaging findings that suggest several potential diagnoses. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Benign Prostatic Hyperplasia (BPH): The enlarged prostate (47cc) with indentation of the bladder base and signs of outlet obstruction (incomplete emptying of the bladder, trabeculated bladder contour) strongly suggest BPH as the primary cause of LUTS.

• Other Likely Diagnoses

  • Chronic Retention: Indicated by the post-micturition volume of 52mL, suggesting that the patient is not fully emptying their bladder.
  • Urinary Tract Infection (UTI) or Prostatitis: Although not directly indicated by the imaging findings, these conditions can cause LUTS and should be considered, especially if the patient has symptoms such as dysuria, frequency, or pain.
  • Overactive Bladder: The trabeculated bladder contour could also suggest overactive bladder, which can cause urinary frequency, urgency, and incontinence.

• Do Not Miss Diagnoses

  • Prostate Cancer: Although the primary finding is an enlarged prostate, it is crucial to rule out prostate cancer, especially in older males, as it can present similarly to BPH.
  • Bladder Cancer: Given the patient's age and LUTS, bladder cancer should be considered, particularly if there are risk factors such as smoking or exposure to certain chemicals.
  • Neurogenic Bladder: This condition, resulting from a neurological condition affecting bladder control, can cause similar symptoms and should be considered if there are suggestive neurological findings.

• Rare Diagnoses

  • Bladder Outlet Obstruction due to Other Causes (e.g., bladder neck contracture, urethral stricture): These are less common causes of LUTS but should be considered if BPH and other common causes are ruled out.
  • Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which could be considered if other diagnoses are excluded and symptoms persist.
  • Stones in Other Locations (e.g., ureteral stones): Although a non-obstructing renal calculus is noted, the possibility of other stones causing obstruction should be considered if symptoms worsen or change.